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相關文獻
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頁籤選單縮合
題 名 | Laparoscopic-assisted Versus Open Surgery for Rectal Cancer=直腸癌在腹腔鏡手術和傳統剖腹手術的比較 |
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作 者 | 江驊哲; 陳自諒; 吳思穎; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
卷 期 | 21:2 2010.06[民99.06] |
頁 次 | 頁79-86 |
分類號 | 416.245 |
關鍵詞 | 腹腔鏡手術; 短期預後; 直腸癌; Laparoscopic surgery; Short-term outcome; Rectal cancer; |
語 文 | 英文(English) |
中文摘要 | 目的 這篇文章的目的在於比較單一機構的直腸癌病人,接受腹腔鏡手術或傳統開腹手 術短期預後的不同。 方法 從2006 年九月到2008 年八月,在中國醫藥大學附設醫院接受直腸癌手術的病人 的所有病人。施行緊急手術的病人排除在外。病人在經過醫師的詳盡解釋後,選擇腹腔 鏡手術或者傳統剖腹手術。臨床上腫瘤侵犯深度超過漿膜層的病人或者淋巴結侵犯呈陽 性者,則施與手術前的合併的放射及化學治療,兩個手術方式的團隊是相同的,所有的 病人都根據NCCN 腫瘤臨床指南追蹤,追蹤的時間為半年。 結果 總共有151 位病人包含在這個研究,76 個病人選擇腹腔鏡手術而75 個病人選擇 剖腹手術。包含了99 位病人接受低位直腸切除 (腹腔鏡手術/剖腹手術:45/54),13 位 病人接受腹部會陰部聯合切除 (腹腔鏡手術/剖腹手術:9/4),12 位病人接受Hartmann 術式 (腹腔鏡手術/剖腹手術:4/8),而27 位病人接受低位直腸切除合併手縫式經肛門 之肛門大腸吻合 (腹腔鏡手術/剖腹手術:18/9)。由腹腔鏡手術轉為開腹手術的病人有7 位 (9.2%)。手術後的併發症在腹腔鏡手術有18 位,而在剖腹手術有14 位。住院時間 而言剖腹手術有較長的住院天數 (12 與10 天;p < 0.001)。腹腔鏡手術相對於剖腹手術 來說,有較少的失血量 (145 與218 cc;p < 0.001),但是卻有較長的手術時間 (234 與181 分鐘;p < 0.001)。 結論 腹腔鏡直腸手術在直腸癌是一種安全且可行的方式,這種方式並不影響短期的腫 瘤及手術預後,如標本移除的長度、遠端的安全範圍、以及淋巴結取得的數目。它也可 以減少病人的住院天數以及手術的失血量。然而,這仍需要長期的追蹤以及更多的病人 數印證他的可行性以及長期的預後。 |
英文摘要 | Purpose. The aim of this study was to compare the short-term outcome for consecutive patients undergoing either laparoscopic or open rectal resection for cancer in a single specialized institution. Methods. All patients with rectal cancer admitted to our institution from September 2006 to August 2008 were included in the study. Patients who underwent emergency operation were excluded. Patients were given the option of laparoscopic or open colectomy and asked to choose after thorough explanation of the pros and cons of each procedure. Patients who had clinical T3 stage cancer or positive lymph nodes were treated with preoperative chemoradiotherapy. The same surgical team was used for all surgical procedures and all patients were prospectively followed for a minimum period of 6 months, in accordance with NCCN Clinical Guidelines in Oncology. Results. Of the 151 consecutive patients in the study, 76 chose to undergo laparoscopic colectomies while 75 decided on open surgery. The procedures included low anterior resection with staple anastomosis for 99 patients (laparoscopy/convention: 45/54), abdominoperineal resection for 13 patients (laparoscopy/convention: 9/4), Hartmann’s procedure for 12 patients (laparoscopy/convention: 4/8), and low anterior resection with hand-sewn transanal coloanal anastomosis for 27 patients (laparoscopy/ convention: 18/9). Conversion to an open procedure occurred for 7 patients (9.2%). Postoperative complications developed in 18 patients in laproscopy group and 14 patients in the conventional group. The length of hospital stay for the conventional group was significantly longer than that of laparoscopic group (12 vs 10 days; p < 0.001). Furthermore, laparoscopic surgery offers decreased rate of blood loss (145 vs 218 cc; p < 0.001), but higher operative time compared to open surgery (234 vs 181 minutes; p < 0.001). Conclusion. Laparoscopic resection is a safe and feasible method of operation for rectal cancer. It does not affect the early surgical oncological outcome, such as length of specimen removed, distal margin, and number of lymph node identified. It also offers decreased rate of blood loss and shorter lengths of hospital stay. However, longer follow-up duration and larger sample sizes will be needed to reveal definitive long-term results of laparoscopic-assisted surgery. |
本系統中英文摘要資訊取自各篇刊載內容。