腹腔镜下肝切除术中转开腹的相关因素初步分析

目的:探讨腹腔镜肝切除术的手术经验、中转开腹相关因素及预防措施。方法:回顾分析2013年11月至2015年11月45例施行腹腔镜肝切除术患者的临床资料,包括是否中转开腹、年龄、性别、术后病理诊断、既往手术史、手术时间、术中出血及住院时间。结果:42例行完全腹腔镜肝切除术,3例中转开腹,其中2例因术中出现不可控的大出血,1例为肿瘤位置不能充分暴露,中转开腹率6.67%。手术时间平均(80±25)min,出血量平均(150±55)ml,术后平均住院(7.1±1.5)d。除术中出血及暴露不充分为腹腔镜肝切除中转开腹的主要因素外,上腹部手术史(P=0.016)、病程(t=3.94,P=0.013)也是中转开腹的相关因素。结论:术中难以控制的出血、手术视野暴露不充分是腹腔镜肝切除术中转开腹的主要原因,上腹部手术史、病程也是中转开腹的因素之一。术前评估患者的既往手术史、病史、肝功能、凝血等情况极为重要,完全腹腔镜下肝切除是安全、有效、微创的术式,但因为肝脏血供丰富、体积较大,对术者技术水平的要求相对较高。     

不解剖肝段血管的完全腹腔镜肝左外叶切除术临床分析

目的:总结完全腹腔镜与传统开放肝左外叶切除术的临床疗效与手术方法。方法:回顾分析2010年2月至2014年2月62例肝左外叶切除术患者的临床资料,其中腹腔镜组32例,常规开腹组30例。对比两组手术时间、术中失血量、患者术后下床活动时间、手术并发症发生率、住院时间等指标。结果:手术均顺利完成,腹腔镜组无一例中转开腹,术后无严重并发症发生。开腹组术后2例发生切口感染。两组术中失血量差异无统计学意义,但腹腔镜组手术时间、术后下床活动时间、并发症发生率及住院时间明显优于开腹组。结论:不解剖肝段血管及肝左静脉的完全腹腔镜肝左外叶切除术,具有手术时间短、术后康复快、并发症少的优点,可取代传统开腹手术,有望成为腹腔镜肝左外叶切除术的新技术。     

机器人辅助与传统腹腔镜肝切除术的效果比较

目的:比较达芬奇机器人与传统腹腔镜肝切除术治疗肝脏疾病的优势与弊端。方法:回顾分析2017年7月至2018年7月因肝脏肿瘤或肝内胆管结石行腹腔镜肝切除术的99例患者的临床资料。患者分为腹腔镜组(n=71)与机器人组(n=28),均由同一术者施术,统计分析两组手术方式、围手术期相关因素及术后恢复情况。结果:除3例传统腹腔镜肝切除术中转开腹外,余者均顺利完成手术。两组手术时间、术中失血量、术后并发症及住院时间差异无统计学意义(P>0.05)。结论:达芬奇机器人腹腔镜肝切除术安全、可行,与传统腹腔镜手术相比,在精细操作方面具有一定优势。     

腹腔镜与开腹左肝切除术的前瞻性对照研究

目的 比较腹腔镜与开腹左肝切除术的疗效.方法 前瞻性对照分析2010年5月至2011年6月哈尔滨医科大学附属第一医院92例行左肝切除术患者的临床资料.其中行腹腔镜下左肝切除术者42例(腹腔镜组),行开腹左肝切除术者50例(开腹组).对比腹腔镜与开腹左肝切除术治疗左半肝肿瘤的优缺点.计量资料采用t检验,计数资料采用x2检验和Fisher确切概率法.结果 腹腔镜组患者施行肝左外叶切除29例,左半肝切除13例;其中1例伤及肝中静脉中转开腹.开腹组患者施行肝左外叶部分切除33例,左半肝切除17例.腹腔镜组患者的手术切缘距肿瘤距离为(1.6±0.6)cm,长于开腹组的(1.2±0.4)cm(t =3.81,P＜0.05).但腹腔镜组患者的术中出血量为(158±89) ml,明显少于开腹组的( 292±172) ml(t=4.56,P＜0.05).腹腔镜组患者的术后镇痛时间、胃肠道功能恢复时间和住院时间分别为(1.2±0.3)d、(23±4)h、(7.5±2.8)d,明显短于开腹组的(2.0±1.1)d、(49±7)h、(11.3±4.2)d(t=4.57,21.31,5.00,P＜0.05).腹腔镜组和开腹组患者术后第1天的AST、ALT较术前均有不同程度升高,但腹腔镜组升高的幅度较开腹组小(t=6.73,5.03,P＜0.05);并且开腹组术后PT明显比术前延长(t=2.32,P＜0.05).腹腔镜组患者术后并发症发生率为7％ (3/41),住院费用为(2.5±0.7)万元,均较开腹组的8％(4/50)和(2.6±0.6)万元低,但差异无统计学意义(t=0.74,P＞0.05).开腹组患者中有l例术后因急性肝功能衰竭导致MODS死亡.结论 腹腔镜左肝切除术成功率高,安全可行,与开腹手术比较具有手术创伤小、恢复快、总体疗效显著等优点.     

机器人与腹腔镜肿瘤剜除术治疗胰头部胰岛素瘤的对比研究

目的:探讨机器人与腹腔镜肿瘤剜除术治疗胰头部胰岛素瘤的临床效果。方法:回顾分析2016年1月至2019年10月施行腹腔镜或机器人胰头部胰岛素瘤剜除术22例患者的临床资料。对比分析两组术中出血量、手术时间、中转开腹率、术后住院时间及胰瘘等并发症发生率。结果:22例手术均获成功,无术中输血、术后出血、C级胰瘘、严重感染、二次手术及死亡等并发症发生;术后病理证实为胰腺神经内分泌肿瘤;随访期间,临床症状完全缓解,无肿瘤复发。机器人组与腹腔镜组相比,术中出血量[(65.0±43.18)mL vs.(89.09±118.08)mL]、手术时间[(146.81±84.15)min vs.(171.36±57.71)min]、术后住院时间[(6.70±1.42)d vs.(9.55±5.52)d]、B级胰瘘发生率(9.1%vs.27.3%)差异无统计学意义(P>0.05)。腹腔镜组11例患者中4例中转开腹,中转率36.36%;机器人组11例患者无一例中转开腹,两组中转率差异无统计学意义(P>0.05)。结论:机器人胰头部胰岛素瘤切除术安全、可行,手术成功率可能更高,具有一定的潜在优势。     

手辅助腹腔镜经腹直肠癌切除术的疗效分析

目的:探讨手助腹腔镜(HALS)经腹直肠癌切除术的效益与风险。方法:选择南昌大学第一附属医院2013年1月—2013年7月住院的直肠癌患者50例,按入院后手术顺序先后随机分为HALS组(24例)和腹腔镜辅助(LAS)组(26例),比较两组的手术时间、术中出血量、淋巴结清扫数、中转开腹数、术后肛门首次排气时间、术后并发症、术后住院时间及住院总费用,随访患者术后2年内生活质量评分、肛门不适例数、肿瘤复发数及病死率。结果:手辅助腹腔镜及腹腔镜两组在术中出血量、淋巴结清扫数、术后肛门排气时间、术后并发症、术后2年内肿瘤复发数及病死率均无统计学差异(P0.05),两组在手术时间、中转开腹数、术后住院时间、住院费用、术后2年生活质量评分及肛门不适数方面HALS组均优于LAS组(P0.05)。结论:与LAS下经腹直肠癌切除术相比,HALS术在缩短手术及术后住院时间、减少中转开腹率、降低住院费用、提高患者术后生活质量等方面具有明显效益,同时可以达到LAS术同样肿瘤根治效果。     

腹腔镜结直肠癌切除术手术相关中转开腹的危险因素分析

【摘要】〓目的〓评估腹腔镜结直肠癌切除术手术相关中转开腹的危险因素。方法〓回顾性分析我院自2002年1月至2012年1月共813例腹腔镜结直肠切除术的病例资料,其中中转开腹的患者68例。比较中转开腹和腹腔镜组两组患者的一般临床资料、围手术期数据、短期临床疗效。结果〓手术中转开腹率为8.3%,IV期疾病、T4期肿瘤、肿瘤长度>5 cm,手术术式、腹部手术史均为中转开腹的独立危险因素。在手术相关数据方面,虽然手术时间未开腹组较开腹组略长,但开腹组在术中失血量(262.4 mL vs. 104.3 mL,P<0.001)和输血量(126.8 ml VS 17.8 mL P<0.001)上,均明显高于未开腹组。在术后短期临床疗效方面,两组在恢复软食时间(3.82 vs 4.63天,P<0.001),肛门开始排气时间(2.95 vs. 3.41天,P<0.001),下床活动时间(2.37 vs. 3.14天,P<0.001),住院时间(18.9 vs. 22.4天,P<0.001)上均具有明显的统计学差异。结论〓T4期肿瘤、IV期疾病分期、腹部手术史、肿瘤直径大于5 cm和手术术式都是影响术中中转开腹的独立因素。     

吲哚菁绿荧光导航技术在腹腔镜解剖性肝切除术中的应用

目的:探讨腹腔镜解剖性肝切除术中应用吲哚菁绿荧光导航技术的疗效。方法:回顾分析2018年3月至2021年12月为31例肝癌患者应用吲哚菁绿荧光导航技术行腹腔镜解剖性肝切除术的临床资料，分析中转开腹率、术中出血量、肝门阻断时间、手术时间、肿瘤直径、术后病理、切缘情况、术后并发症、住院时间、术后复发情况及生存情况。结果:1例中转开腹，余者均在吲哚菁绿荧光导航技术下完成腹腔镜肝段/肝叶解剖性切除术。中转开腹率为3.2%(1/31),术中出血量为200(100～400)mL,肝门阻断时间13(0～20)min,手术时间185(135～225)min,肿瘤直径(2.6±1.3)cm,住院10(8～14)d。术后切缘病理阳性1例(3.2%),术后病理肝细胞癌28例、胆管细胞癌2例、混合癌1例，术后Clavien分级Ⅰ级19例、Ⅱ级10例、Ⅲ级2例。结论:应用吲哚菁绿荧光导航技术行腹腔镜解剖性肝切除术有助于术中切肝平面的确认，并对荷瘤肝段进行精确显影与术中导航，同时可对术中胆漏进行判断。在有明确适应证的情况下，此技术值得临床推广。     

腹腔镜下不同术式治疗巨大肝血管瘤的疗效分析

目的:总结腹腔镜肝血管瘤剥除术与解剖性肝切除术治疗巨大肝血管瘤的临床效果。方法:回顾分析2017年1月至2020年12月腹腔镜手术治疗的90例巨大肝血管瘤患者的临床资料,其中38例行血管瘤剥除术(剥除组),52例行解剖性肝切除术(肝切组),对比分析两组手术情况、术后恢复情况、住院时间、住院费用等相关指标。结果:82例患者顺利完成腹腔镜手术,8例中转开腹。剥除组手术时间、术中出血量、住院费用均低于肝切组,差异有统计学意义(P<0.05);两组术中肝门阻断时间、中转开腹率、术后第1天实验室指标、并发症发生率及住院时间差异均无统计学意义(P>0.05)。术后随访5～39个月,17例失访,余73例患者均未见明显异常。结论:腹腔镜手术治疗巨大肝血管瘤是安全、可行的,解剖性肝切除术及血管瘤剥除术均是有效的治疗方案,但血管瘤剥除术较肝切除术操作更加简单,且手术出血少,创伤小,治疗费用低,对于外生型及肝脏边缘的血管瘤更具优势。     

腹腔镜胆囊切除术14例中转开腹原因的分析

目的探讨如何提高腹腔镜胆囊切除术的成功率,减少并发症的发生率。方法对2002年7月~2004年8月间共439例腹腔镜胆囊切除术的临床资料进行回顾性分析,研究中转开腹的原因和并发症的处理方式。结果本组LC439例中转开腹14例,中转率3.19%。其中主动中转开腹12例,肝总管横断1例,合并结肠肝曲肿瘤1例。术后4例发生胆漏。结论LC是胆囊良性疾病的首先术式。严格掌握LC的手术适应证,提高镜下操作技术,及时中转开腹,可减少术后并发症。     

Laparoscopic liver resection: Experience based guidelines

Laparoscopic liver resection(LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant(both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments(1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of lap-aroscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.     

腹腔镜肝切除术11例临床报告

目的:探讨腹腔镜肝切除术的适应证和可行性。方法:回顾分析10例病灶位于肝脏边缘及左肝外叶(Ⅱ～Ⅵ段)及1例位于Ⅷ段的肝占位患者的临床资料。其中原发性肝细胞癌8例,肝海绵状血管瘤2例,胆管细胞癌1例,肝功能Child-Pugh评分A级9例,B级2例;AFP(+)7例;位于左肝外叶实质中的肿瘤,行规则性左肝外叶切除;位于肝脏边缘或右肝表面的肿瘤,行肝脏局部切除。结果:11例均成功完成腹腔镜肝切除术,无中转开腹。其中局部切除术7例,左肝外叶切除术4例,腹腔镜脾切除+胆囊切除术2例。平均手术时间105min,术中平均出血220ml,切除病灶最大直径10cm。全部肿瘤均完整切除,肿瘤包膜完整,无破裂。术后未发生胆漏和出血等并发症,恢复良好,术后平均住院8.5d。结论:位于肝脏边缘、右肝表面或左半肝(Ⅱ～Ⅵ段)的肝脏占位,行腹腔镜肝切除术是安全可行的。     

Laparoscopic management of benign solid and cystic lesions of the liver

OBJECTIVE: The authors present their experience in the laparoscopic management of benign liver disease. The aim of the study is to analyze technical feasibility and evaluate immediate and long-term outcome. SUMMARY BACKGROUND DATA: Indications for the laparoscopic management of varied abdominal conditions have evolved. Although the minimally invasive treatment of liver cysts has been reported, the laparoscopic approach to other liver lesions remains undefined. METHODS: Between September 1990 and October 1997, 43 patients underwent laparoscopic liver surgery. There were two groups of benign lesions: cysts (n = 31) and solid tumors (n = 12). Indications were solitary giant liver cysts (n = 16), polycystic liver disease (n = 9), hydatid cyst (n = 6), focal nodular hyperplasia (n = 3), and adenoma (n = 9). Only solid tumors, hydatid cysts, and patients with polycystic disease and large dominant cysts located in anterior liver segments were included. All giant solitary liver cysts were considered for laparoscopy. Patients with cholangitis, cirrhosis, and significant cardiac disease were excluded. Data were collected prospectively. RESULTS: The procedures were completed laparoscopically in 40 patients. Median size was 4 cm for solid nodules and 14 cm for solitary liver cysts. Conversion occurred in three patients (7%), for bleeding (n = 2) and impingement of a solid tumor on the inferior vena cava (n = 1). The median operative time was 179 minutes. All solitary liver cysts were fenestrated in less than 1 hour. There were no deaths. Complications occurred in 6 cases (14.1%). Two hemorrhagic and two infectious complications were noted after management of hydatid cysts. There were no complications after resection of solid tumors. Three patients received transfusions (7%). The median length of stay was 4.7 days. Median follow-up was 30 months. There was no recurrence of solitary liver or hydatid cysts. One patient with polycystic disease had symptomatic recurrent cysts at 6 months requiring laparotomy. CONCLUSION: Laparoscopic liver surgery can be accomplished safely in selected patients with small benign solid tumors located in the anterior liver segments and giant solitary cysts. The laparoscopic management of polycystic liver disease should be reserved for patients with a limited number of large, anteriorly located cysts. Hydatid disease is best treated through an open approach.     

Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results

BACKGROUND: Liver surgery, especially for cirrhotic patients, is one of the last areas of resistance to progress in laparoscopic surgery. This study compares the postoperative results and the 2-year patient outcomes between laparoscopic and open resection for hepatocellular carcinoma in patients with histologically proven cirrhosis. METHODS: From May 2000 to October 2004, 23 consecutive cirrhotic patients who underwent laparoscopic hepatectomy (LH) for HCC were compared in a retrospective analysis with a historic group of 23 patients who underwent open hepatectomy (OH). The two groups were well matched for age, gender, American Society of Anesthesiology (ASA) class, tumor location and size, type of liver resection, and severity of cirrhosis. The selection criteria for both groups specified a small (size < 5 cm), exophytic, or subcapsular tumor located in the left or peripheral right segments of the liver (II-VI segments, Couinaud); a well-compensated cirrhosis (Child-Pugh A); and an ASA score lower than 3. In the LH group, 15 subsegmentectomies, 3 segmentectomies, and 5 left lateral sectionectomies were performed, as compared with 12 subsegmentectomies, 5 segmentectomies, and 6 left lateral sectionectomies in the OH group. RESULTS: One patient in the LH group (4.3%) underwent conversion to laparotomy for inadequate exposition. The mean operative time was statistically longer for the LH group (LH, 148 min; OH, 125 min; p = 0.016), whereas blood transfusions (LH, 0%; OH, 17.3%; p = 0.036), Pringle maneuver (LH, 0%; OH, 21.73%; p = 0.017), mean hospital stay (LH, 8.3 days; OH, 12 days; p = 0.047), and postoperative complications (LH, 13%; OH, 47.8%; p = 0.010) were significantly greater in OH group. There was no statistically significant difference in mortality and 2-year survival rates between the two groups. CONCLUSION: This study shows that LH for HCC in properly selected cirrhotic patients results in fewer early postoperative complications and a shorter hospital stay than the traditional OH. The 2-year survival rate was the same for LH and OH.     

Complications of Liver Resection: Laparoscopic Versus Open Procedures

Background and Objective:

Minimally invasive surgery for liver resection remains controversial. This study was designed to compare open versus laparoscopic surgical approaches to liver resection.

Methods:

We performed a single-center retrospective chart review.

Results:

We compared 45 laparoscopic liver resections with 17 open cases having equivalent resections based on anatomy and diagnosis. The overall complication rate was 25.8%. More open resection patients had complications (52.9% vs 15.5%, P < .008). The conversion rate was 11.1%. The mean blood loss was 667.1 ± 1450 mL in open cases versus 47.8 ± 89 mL in laparoscopic cases (P < .0001). Measures of intravenous narcotic use, intensive care unit length of stay, and hospital length of stay all favored the laparoscopic group. Patients were more likely to have complications or morbidity in the open resection group than in the laparoscopic group for both the anterolateral (P < .085) and posterosuperior (P < .002) resection subgroups.

Conclusion:

In this series comparing laparoscopic and open liver resections, there were fewer complications, more rapid recovery, and lower morbidity in the laparoscopic group, even for those resections involving the posterosuperior segments of the liver.     

Hand-assisted laparoscopic liver resection: lessons from an initial experience

BACKGROUND: Recent innovations in laparoscopic instrumentation make routine resection of solid organs a clinical possibility. HYPOTHESIS: Hand-assisted laparoscopic liver resection is a safe and feasible procedure for solitary cancers requiring removal of 2 segments of liver or less. DESIGN AND PATIENTS: Eleven patients with liver tumors deemed technically resectable by laparoscopic techniques were subjected to laparoscopic evaluation and attempted hand-assisted laparoscopic resection between July 1998 and July 1999. During the same period, 230 patients underwent open liver resection. SETTING: Tertiary care referral center for liver cancer. MAIN OUTCOME MEASURES: Success of laparoscopic resection, reasons for conversion to open liver resection, blood loss, tumor clearance margin, complications, and length of hospital stay. RESULTS: Five patients underwent successful resection by the hand-assisted laparoscopic technique. Data from the 5 successful cases and the 6 aborted cases are presented to outline the issues and the lessons learned. CONCLUSIONS: In selected patients, hand-assisted laparoscopic liver resection can be safely performed and might have potential advantages over traditional liver resection if the tumor is limited to the left lateral segment or is at the margins of the liver.     

腹腔镜结直肠癌手术与传统开腹手术后复发率比较的Meta分析

目的 对比分析腹腔镜与开腹结直肠癌手术的术后复发率.方法 以laparoscopy、surgery、minimal invasive、colon、intestine,large、colectomy、colonic neoplasms、rectal neoplasms和randomized controlled trial为检索词.检索1991年1月至2007年1月间发表的有关腹腔镜与开腹结直肠癌手术后复发的随机对照研究.按筛选标准,共有10篇研究人选.南3名作者各自独立地对入选研究中有关试验设计、研究对象特征和研究结果等内容进行摘录,并用RevMan 4.2软件进行统计分析.结果 全体研究样本量合计2474例结直肠癌.Meta分析结果显示:腹腔镜结直肠切除术对比开腹手术治疗结直肠癌的术后总体复发率差异无统计学意义,总体复发率合并优势比(OR)为0.95[95%C1 0.76～1.19],P=0.64.按不同复发类型进行独立研究,Meta分析结果显示:腹腔镜结直肠切除术治疗结直肠癌的术后局部复发率、远处转移率及穿刺口或切口种植转移率对比开腹手术均无显著升高,其OR分别为0.79[95%C1 0.50～1.25],P=0.32和0.89[95%C1 0.62～1.28],P=0.54及1.04[95%C1 0.21～5.27],P=0.96.结论 腹腔镜结直肠切除术对比传统开腹手术治疗结直肠癌其术后长期肿瘤学效果相当,并不会导致术后各类复发率明显升高,可成为治疗结直肠癌的标准术式.     

Hand-assisted laparoscopic hepatectomy for solid tumor in the posterior portion of the right lobe: initial experience

OBJECTIVE: To prove the feasibility of hand-assisted laparoscopic liver resection for tumors located in the posterior portion of the right hepatic lobe. SUMMARY BACKGROUND DATA: Use of laparoscopic liver resection remains limited due to problems with technique, especially when the tumor is located near the diaphragm, or in the posterior portion of the right lobe. METHODS: Between October 2001 and June 2002, a total of 7 patients with solid hepatic tumors involving the posterior portion of the right lobe of liver underwent hand-assisted laparoscopic hepatectomy with the HandPort system at our hospital. Surgical techniques used included CO2 pneumoperitoneum and the creation of a wound on the right upper quadrant of the abdomen for HandPort placement. The location of tumor and its transection margin were decided by laparoscopic ultrasound. The liver resection was performed using the Ultrashear without portal triad control, with the specimens obtained then placed in a bag and removed directly via the HandPort access. RESULTS: The 5 male and 2 female patients ranged in age from 41 to 76 years (mean 62.3 +/- 14.4). Surgical procedures included partial hepatectomy for 6 patients and segmentectomy for one, all successfully completed using a variant of the minimally invasive laparoscopic procedure without conversion to open surgery. The mean duration of the operation was 140.7 +/- 42.2 minutes (90-180). The blood loss during surgery was 257.1 +/- 159 mL (250-500), without any requirement for intraoperative or postoperative transfusion. Pathology revealed hemagioma (n = 2), colon cancer metastasis (n = 2), and hepatocellular carcinoma (n = 3). There were no deaths postoperatively, with 1 patient suffering bile leakage. Mean hospital stay was 5.3 +/- 1.3 days postsurgery. CONCLUSION: The results of this study suggest that laparoscopic liver resection using the HandPort system is feasible for selected patients with lesions in the posterior portion of the right hepatic lobe requiring limited resection. Individuals with small tumors may benefit; because a large abdominal incision is not required, the wound-related complication rate might be reduced.     

腹腔镜直肠癌前切除术难易程度的相关因素分析

目的:探讨腹腔镜直肠癌前切除术难易程度的影响因素。方法:对2012年1月至2014年3月112例行腹腔镜直肠癌前切除术患者的临床资料进行单因素分析,筛选出可能影响手术难度的因素,再对影响因素进行Logistic回归分析,从而确定手术难度的相关因素。结果:手术时间130~210 min,中位时间180 min;术中出血量60~150 ml,中位出血量85 ml。8例(7.1%)中转开腹,应用Logistic回归分析确定腹腔镜直肠癌前切除术难度的独立影响因素为男性(P=0.001,OR=13.616)、BMI≥28 kg/m2(P=0.02,OR=16.566)、肿瘤长径≥4 cm(P=0.000,OR=25.440)、肿瘤距肛缘距离<6 cm(P=0.000,OR=70.133)、骨盆坐骨棘间径<9.5 cm(P=0.001,OR=21.503)、骨盆骶尾间距≥12.2 cm(P=0.045,OR=4.320)。结论:男性、肥胖、肿瘤体积大、位置低及深窄骨盆的直肠癌患者,行腹腔镜直肠癌前切除术的难度较大。术前明确影响手术难度的相关因素可评估手术风险,为手术方式的选择提供依据。