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頁籤選單縮合
題名 | Laparoscopic Abdominoperineal Resection for Low Rectal Adenocarcinoma=腹腔鏡經腹部會陰部切除手術治療低位直腸癌 |
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作者姓名(中文) | 柯道維; 陳自諒; 陳宏彰; 黃燈明; 尤昭傑; 林倉祺; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
卷期 | 19:3 2008.09[民97.09] |
頁次 | 頁63-70 |
分類號 | 416.245 |
關鍵詞 | 腹腔鏡經腹部會陰部切除手術; 低位直腸癌; Laparoscopic abdominoperineal resection; LAPR; Low rectal adenocarcinoma; |
語文 | 英文(English) |
中文摘要 | 目的 對於傳統經腹部會陰部切除手術而言,使用腹腔鏡經腹部會陰部切除手術來治療低位直腸癌是另一個被接受可以選擇的手術方式。但是對於腹腔鏡經腹部會陰部切除手術的長期預後追蹤卻較少被提出來討論。本篇研究的目的是要討論利用腹腔鏡經腹部會陰部切除手術治療低位直腸癌的長期預後。 方法 從1999 年到2003 年,有35 位低位直腸癌患者在彰化基督教醫院接受經腹部會陰部切除手術,另外有31 位低位直腸癌患者在同一時期接受傳統經腹部會陰切除手術被提出來做比較。二者的短期預後,如腸道恢復時間、住院天數等以及長期預後,如存活率等被提出來比較分析。另外針對由腹腔鏡手術改為傳統手術的原因、腹腔鏡手術時間長短以及手術併發症等也都有深入討論。 結果 在所有66 位患者中,有31 位接受傳統經腹部會陰部切除手術,有35 位接受腹腔鏡經腹部會陰部切除手術,但其中又有4 位 (11%) 於手術中由腹腔鏡手術改為傳統經腹部會陰部切除手術。手術併發症的比例為24.24%。沒有患者因為接受腹腔鏡或傳統手術而造成死亡。沒有腹腔鏡通氣導管位置或是傳統手術傷口的腫瘤轉移。在患者的特徵:包括體重、身高、BMI 值、麻醉評估分數、術前是否接受化學治療、癌症分期、存活時間、以及平均手術時間,各組都沒有顯著統計學上差異。術中失血量在傳統手術與腹腔鏡手術分別為 (mean ± SD) 619 ± 355.4 ml 與325 ± 292.7 ml (p = 0.001),有統計學上差異。腸道恢復的時間與開始喝水、開始進食的時間在傳統手術與腹腔鏡手術分別為 (mean ± SD) 2.5 ± 0.6 與2 ± 0.8 天 (p = 0.032)、2 ± 0.8 與1.5 ± 0.6 天 (p = 0.015)、3.7 ± 0.9 與3.2 ± 0.9 天,均有統計學上差異 (p < 0.05)。在五年存活率方面:傳統手術與腹腔鏡手術分別為65.72% 與69.40% (p = 0.7723),沒有顯著統計學上差異。有四位患者有術後腫瘤局部復發的情形,復發率為6.06%。五年的遠處器官轉移共有14 位患者,分別在肝臟、肺臟、腎上腺被發現。 結論 對於要接受手術的低位直腸癌患者,除了傳統經腹部會陰部切除手術,腹腔鏡經腹部會陰部切除手術是另一個可選擇的治療方式。 |
英文摘要 | Purpose. Laparoscopic abdominoperineal resection (LAPR) is an accepted alternative to open resection for treating patients with low rectal adenocarcinoma, but the long term results are seldom reported. The purpose of our study was to evaluate the long term outcome in low rectal adenocarcinoma patients treated with laparoscopic abdominoperineal resection. Methods. We reviewed our experience with 35 patients who underwent laparoscopic abdominoperineal resection for low rectal adenocarcinoma at Changhua Christian Hospital between 1999 and 2003, and another 31 low rectal adenocarcinoma patients who accepted open abdominoperineal resection during the same period of time was compared. The patient’s short term outcome, such as bowel function recovery time, duration of hospital stays and long term oncological result were recorded and analyzed. The option for conversion rate, laparoscopic operation time and complication were also discussed. Results. Of 66 total patients, 31 were in the open group and 35 were in the laparoscopic group; 4 (11%) of the latter were converted to open surgery. The overall complication rate in this study is 24.24% and there was no operative mortality in the study. No port-site metastasis was found in laparoscopic group, and no surgical wound metastasis was found in open group. No statistically significant difference in body weight, height, BMI, anesthesia score, pre-operative chemoradiotherapy, cancer stage, survival time, and mean operative time was found among the 3 groups. Blood loss for open surgery and completed laparoscopic resection were (mean ± SD) 619 ± 355.4 mL vs 325 ± 292.7 mL(p = 0.001). The time that bowel function resumed, time to ingestion of water, and time to resumption of solid foods between the open and laparoscopic groups were (mean ± SD) 2.5 ± 0.6 vs 2 ± 0.8 days (p = 0.032), 2 ± 0.8 vs 1.5 ± 0.6 days (p = 0.015), and 3.7 ± 0.9 vs 3.2 ± 0.9 days , respectively (p < 0.005). The over all survival rates at 5 years were 65.72% in open group and 69.40% in laparoscopic group (p = 0.7723).There are four local recurrent (6.06%) in the study. Distal metastasis at 5 years follow-up was noted in 14 patients and located at liver, lung and adrenal gland. Conclusion. Laparoscopic abdominoperineal resection is a feasible alternative to the conventional open technique for the treatment of patients with low rectal adenocarcinoma. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。