腹腔镜下直肠癌根治术下腹部辅助切口选择的临床研究

目的探讨腹腔镜下直肠癌根治术采用下腹部辅助纵切口(简称纵切口)与耻骨上辅助横切口(简称横切口)两种切口方式的优劣。方法回顾性分析2012年8月至2015年12月行腹腔镜直肠癌根治术并有术后完整随访记录的患者临床资料,按腹部辅助切口方式分成纵切口组和横切口组,术后采用复查随访,随访时间截止至2016年5月。采用SPSS 19.0软件,术中手术指标、术后疼痛评分数据以x珋±s表示,采用t检验;术后并发症发生率比较采用卡方检验。P0.05认为差异有统计学意义。结果有93例患者纳入了本次研究,纵切口组42例,横切口组51例。两组患者在手术时间、术中出血量、肿瘤大小、术后通气时间、术后住院时间等差异无统计学意义(P0.05);横切口长度为(4.4±0.8)cm,纵切口长度为(4.9±0.7)cm,两组比较差异有统计学意义(P0.05);术后疼痛评分(VAS评分),横切口组在24 h和72 h低于纵切口组,差异有统计学意义(P0.05);纵切口组术后切口感染率为14.3%,横切口组术后切口感染率为2.0%,两组比较差异有统计学意义(P0.05)。结论腹腔镜下直肠癌根治术采用耻骨上横切口在减少术后切口相关并发症方面明显优于下腹部纵切口,值得临床应用和推广。

Clinical analysis of lower abdominal auxiliary incision selection in laparoscopic radical rectectomy for rectal cancer

Objective To investigate clinical outcome of lower abdominal midline incision and suprasymphysary transverse incision in laparoscopic radical rectectomy for rectal cancer.Methods From August 2012 to December 2015,retrospective analysis were performed in patiens who underwent laparoscopic radical rectectomy for rectal cancer,with complete follow-up records.Enrolled patients were divided into the lower abdominal midline incision group and suprasymphysary transverse incision group.All of enrolled patients were followed up till May 2016.Statistical analysis were performed by using SPSS 19.0 software.The measurement data such as intraoperative indexes and the VSA scores were expressed as mean ± standard deviation ((x) ± s),and were examined by using t test.Count data such as complication rate (％) were examined by using x2 test.A P value ＜ 0.05 was considered as statistically significant difference.Result 93 patients were enrolled in this study:lower abdominal midline incision group (n =42) and suprasymphysary transverse incision group(n =5 1).There were no significant difference between 2 groups in terms of operation time,intraoperative blood loss,tumor size,time of exhaust and postoperative hospital stay (P ＞ 0.05).The midline incision of (4.4 ± 0.8) cm was shorter than suprasymphysary transverse incision of (4.9 ±0.7) cm with significant difference (P ＜0.05).There were significant difference in terms of Visual Analogue Score between 2 groups post operation 24 h and 72 h (P ＜ 0.05) The incision infection rate in the transverse incision group was 2.0％,which was significantly lower than 14.3％ in the midline incision group (P ＜ 0.05).Conclusion By using suprasymphysary transverse incision could benefit patients in reducing postoperative complications than lower abdominal midline incision in laparoscopic radical rectectomy for rectal cancer.It is worth of clinical promotion in future.