3D与2D腹腔镜系统在结直肠癌手术应用的随机对照研究

目的研究3D腹腔镜系统在结直肠癌根治术中手术操作技术、术后短期疗效、可行性、安全性及肿瘤根治性。方法采用前瞻性分析法,收入2013年11月至2015年6月在上海市微创外科临床医学中心进行腹腔镜结直肠癌根治术的74例病人,按照随机数字表法分为2D(高清)腹腔镜组及3D腹腔镜组。2D腹腔镜组共38例,其中男性20例、女性18例,中位年龄为60.5岁(46~83岁);3D腹腔镜组共36例,其中男性16例、女性20例,中位年龄为62岁(37~84岁)。38例2D腹腔镜组病人中,腔镜右半结肠癌根治术12例,腹腔镜左半结肠癌根治术4例,腹腔镜横结肠癌根治术1例,腹腔镜乙状结肠癌根治术2例,腹腔镜根治性直肠前切除术17例(其中3例行末端回肠造口术),腹腔镜腹会阴联合直肠癌根治术2例。36例3D腹腔镜病人中,腹腔镜右半结肠癌根治术15例,腹腔镜左半结肠癌根治术3例,腹腔镜横结肠癌根治术1例,腹腔镜乙状结肠癌根治术3例,腹腔镜根治性直肠前切除术10例(其中5例行末端回肠造口术),腹腔镜腹会阴联合直肠癌根治术4例。结果所有病例均成功接受手术,无术中严重并发症和手术死亡发生,无中转开腹手术。2D腹腔镜组平均手术时间为(153.3±54.9)min,平均术中出血为(117.9±102.5)ml,平均排气时间为(2.3±0.9)d,平均住院天数为(9.6±7.8)d。3D腹腔镜组平均手术时间为(152.9±48.3)min,与2D腹腔镜组比较P=0.973;平均术中出血为(100.3±66.3)ml,与2D腹腔镜组比较P=0.386;平均排气时间为(2.1±0.8)d,与2D腹腔镜组比较P=0.228;平均住院天数为(8.1±3.2)d,与2D腹腔镜组比较P=0.289。术后2D腹腔镜组有1例腹腔镜根治性直肠前切除术及1例腹腔镜右半结肠癌根治术出现吻合口漏;3D腹腔镜组有1例腹腔镜腹会阴联合直肠癌根治术出现会阴切口感染。以上病人予对症治疗后均好转,无行二次手术病人。结论 2D腹腔镜系统与3D腹腔镜系统在手术操作上相似,两者手术后临床短期疗效、肿瘤根治程度相当。进一步研究尚需病例的积累与远期疗效的观察。

Randomized controlled study:comparative study on clinical efficacy between 3D and 2D laparoscopic radical colorectaomies in the cases of colorectal cancer

Objective To investigate the operative technique,postopertaive recovery,feasibility and safety of the 3D laparoscopy system in colorectal surgery.Methods The clinical and follow-up data of 74 patients with colorectal carcinoma who underwent laparoscopic radical resection in Shanghai Minimally Invasive Surgery Center between November 2013 and June 2015 were analyzed prospectively.According to random number table,74 patients were divided into the following groups:2D laparoscopy system group and 3D laparoscopy system group.In the 38 cases of 2D laparoscopy system group (20 males,and 18 females),the average age was 60.5 years old (range 46-83 years);In the 36 cases of 3D laparoscopy system group (16 males,and 20 females),the average age was 62 years old (range 3784 years).In the 2D laparoscopy system group,12 cases were given laparoscopic right hemicolectomies,4 cases given laparoscopic left hemicolectomies,1 case given laparoscopic transverse colectomy,2 cases given laparoscopic sigmoidectomies,17 cases given laparoscopic radical resections of rectal carcinoma (3 cases subject to ileostomies) and 2 cases given laparoscopic abdominoperineal radical resections of the rectum.In the 3D laparoscopy system group,15 cases were subjected to laparoscopic right hemicolectomies,3 cases to laparoscopic left hemicolectomies,1 case to laparoscopic transverse colectomy,3 cases to laparoscopic sigmoidectomies,10 cases to laparoscopic radical resections of rectal carcinoma (5 cases to ileostomies) and 4 cases to laparoscopic abdominoperineal radical resections of the rectum.Results There was no conversion to open surgery,intraopertaive complications or operation related deaths.In the 2D laparoscopy system group,the mean operation time was (153.3 ± 54.9) min,and the mean blood loss was (117.9 ± 102.5) mL.The mean flatus time was (2.3 ± 0.9) days,and the mean hospital stay was 9.6 ± 7.8 days.In the 3D laparoscopy system group,the mean operation time was (152.9 ± 48.3) min (P =0.973),and the mean blood loss was (100.3 ± 66.3) mL (P =0.386).The mean flatus time was (2.1 ± 0.8) days (P =0.228),and the mean hospital stay was (8.1 ± 3.2)days (P =0.289).In the 2D laparoscopy system group,anastomotic leakage occurred in 2 cases in the group of laparoscopic right hemicolectomy and laparoscopic radical resections of rectal carcinoma.In the 3D laparoscopy system group,wound infection occurred in one case in the group of laparoscopic abdominoperineal radical resections of the rectum.Conclusions We concluded that the 3D laparoscopy system was similar to the traditional 2D laparoscopy system in surgical procedures and clinical effects.More studies with larger samples are required to evaluate the impact of 3D laparoscopy system.