腹腔镜与开腹直肠癌病例对照研究

南京医科大学七年制医学硕士专业学位论文目录中文摘要.......................................................................................................................1英文摘要.......................................................................................................................2前言.............................................................................................................................4正文...............................................................................................................................61资料和方法...............................................................................................................61.1病例选择.....................................................................................................61.2术前准备.....................................................................................................61.3手术方式.....................................................................................................61.4观察指标及判定方法.................................................................................71.5术后化疗.....................................................................................................71.6术后随访.....................................................................................................81.7统计学分析.................................................................................................82结果...........................................................................................................................92.1临床资料.......................................................................................................92.2手术及标本结果...........................................................................................92.3病理结果......................................................................................................112.4围手术期并发症.........................................................................................132.5术后恢复情况.............................................................................................152.6术后镇痛药物使用情况及术后疼痛程度.................................................152.7经济学成本.................................................................................................162.8术后近远期生存率.....................................................................................163讨论.........................................................................................................................194结论.........................................................................................................................23参考文献.....................................................................................................................24中英文对照词表.........................................................................................................28综述.............................................................................................................................29攻读学位期间发表文章情况.....................................................................................38致谢.............................................................................................................................39南京医科大学七年制医学硕士专业学位论文1摘要【目的】本研究通过回顾性病例对照研究比较腹腔镜与开腹直肠癌根治术的安全性与可行性、根治性及临床疗效。【方法】收集2006年1月至2013年12月在我院接受腹腔镜直肠癌根治术（LRR组）492例及同期接受开腹直肠癌根治术（ORR组）424例患者的临床病例资料，对两组患者的一般资料、手术情况、病理资料、术后恢复和并发症情况及远期生存等进行回顾性分析，探讨腹腔镜直肠癌根治手术的疗效。【结果】两组患者在性别、年龄、身高、体重、BMI、肿瘤位置、肿瘤TNM分期、肿瘤细胞分化程度和ASA分级等方面差异均无统计学意义（P＞0.05）。LRR组手术时间短于ORR组（P0.001），LRR组术中出血较少（P0.001），LRR组中转开腹率为2.439%。LRR组患者术后使用镇痛药物、术后肠道功能恢复时间、开放饮食时间及平均住院天数均明显短于ORR组患者（P0.001）。LRR组淋巴结清扫数略多于ORR组，但无明显统计学差异（P=0.338），两组获取的手术标本长度及标本切缘无明显差异（P=0.182）。两组围手术期并发症发生率相似（P=0.081），其中LRR组术中并发症与ORR组相似（P=0.180），近期并发症发生率较ORR组低（P=0.028）。术后随访率为95.09%，ORR组及LRR组1年总生存率分别为94.0%和93.6%（P=0.534），3年总生存率分别为78.1%和80.9%（P=0.052），5年总生存率分别为75.2%和77.0%（P=0.416）。【结论】腹腔镜直肠癌根治术手术安全、可行，具有术后创伤小、疼痛轻、胃肠道功能恢复快、住院时间短、不增加围手术期并发症等优势；长期随访结果揭示腹腔镜手术后患者长期生存方面与开腹手术相似，不增加患者肿瘤局部复发及转移发生率，值得临床推广。【关键词】腹腔镜手术，直肠癌，肿瘤根治性，临床疗效南京医科大学七年制医学硕士专业学位论文2ComparisonbetweenLong-termSurvivalandSafetyofLaparoscopyandOpenSurgeryforRectalCancerABSTRACTOBJECTIVEThisstudyaimedtocomparethesafetyandlong-termsurvivalofpatientswhounderwentlaparoscopic(LRR)andopenresections(ORR)forrectalcancerbyretrospectiveanalysisofcase-controlstudy.METHODSBetweenJan2006andDec2013,492patientswithrectalcarcinomaunderwentLRRbylaparoscopicsurgeon.Thesepatientswerecomparedwith424casesunderwentconventionalORRbyrectalsurgeon.Clinicaldataaboutthepatientswerecollectedprospectively.Evaluatedtheclinicaleffectoflaparoscopicradicalsurgeryforrectalcancerbycomparingtheoperativedetailsandlong-termoutcomesbetweenlaparoscopicandopenresection.RESULTSTherewasnosignificantdifferencebetweenthetwogroups(P0.05)intermsofgender,age,height,weight,BMI,tumorlocation,tumorTNMstage,tumorcelldifferentiationandASAclassificationandsoon.TheoperativetimeofLRRwasshorterthanORR(P0.001),andLRRhaslesshemorrhagicthanORR(P0.001),TheconversionrateofLRRwas2.439%.Patientswithlaparoscopicresectionhadearlierretur