腹腔镜结直肠癌根治术不同术中转开腹时机及3年生存期分析

目的分析腹腔镜结直肠癌根治术不同术中转开腹时机对患者安全性及3年生存期的影响。方法回顾性队列研究2015年1月至2017年1月实施结直肠癌根治术的75例结直肠癌患者临床资料,将腹腔镜术切皮后1 h内中转开腹的43例患者纳入早期组,将切皮后1 h后中转开腹的32例患者纳入延迟组。采用SPSS23.0软件进行处理,围术期各项相关指标、肠道功能以(±s)表示,独立t检验;并发症、生存率用百分比表示,用χ²检验或Fisher精确检验,采用Kaplan-meier计算生存率,P<0.05为差异有统计学意义。结果早期组手术时间、术后首次排便及排气时间、术后住院时间、术中出血量均少于延迟组(P<0.05);术后3个月MSKCC评分早期组各项评分均比延迟组高(P<0.05);早期组术后并发症发生率(7.0%)较延迟组(25.0%)低(P<0.05);早期组术后1、2、3年生存率(100.0%、88.4%、72.1%)与延迟组(93.8%、81.3%、62.5%)比差异无统计学意义(P>0.05)。结论腹腔镜术切皮后1 h内中转开腹手术可促进直肠癌根治术患者术后肠道功能恢复,减少术后并发症,加快术后康复进程,近期疗效及安全性较高。

Clinical analysis of the conversion timing in laparoscopic radical surgery and 3-year survival of patients with colorectal cancer

Objective To investigate the conversion timing in laparoscopic radical surgery,safety and 3-year survival of patients with colorectal cancer.Methods Retrospective cohort study were performed in 75 patients with colorectal cancer who underwent laparoscopic radical resection from January 2015 to January 2017.43 patients underwent conversion to open surgery within 1 hour after laparoscopic surgery,were divided into the early group.32 patients underwent conversion to open surgery>1 hour after laparoscopic surgery were divided into the delayed group.Statistical analysis were performed by using SPSS 23.0 software.The perioperative related indicators and intestinal function were expressed as,and were analyzed by using independent t test.Complications and survival rate were expressed as percentage and were analyzed by usingχ² test or Fisher exact test The survival was calculated by using the Kaplan-meier method.A P value of<0.05 was considered as statistically significant difference.Results The operation time,first defecation and exhaust time,and postoperative hospital stay were shorter in the early group than those in the delayed group respectively(P<0.05),while intraoperative blood loss was less than that in the delayed group(P<0.05).At 3 months after operation,MSKCC scores in the early group were higher than those in the late group(P<0.05).Postoperative complications of 7.0%in the early group was lower than 25.0%in the delayed group.The 1,2 and 3-year survival of 100.0%,88.4%and 72.1%in the early group were not significantly different from 93.8%,81.3%and 62.5%in the late group respectively(P>0.05).Conclusions The conversion to open surgery within 1 hour after laparoscopic surgery could promote the recovery of intestinal function in patients underwent radical colorectal cancer surgery,with less postoperative complications,and promote postoperative rehabilitation process,with better short-term curative effect and safety.