减孔腹腔镜高位直肠或乙状结肠癌根治术的临床研究

目的：探讨减孔腹腔镜高位直肠或乙状结肠癌根治术的安全性和可行性。方法回顾性分析2013年1月至2014年7月间上海瑞金医院北院普通外科行腹腔镜高位直肠或乙状结肠癌根治术治疗的70例患者临床病理资料，其中常规组（5孔）26例，减孔组（3孔或4孔）44例。比较两组手术时间、出血量、淋巴结清扫数、术后排气时间、饮食时间、术后住院时间及并发症情况。结果常规组与减孔组患者的手术时间[（144．0±40．1） min比（115．8±30．8） min]、出血量[（72．9±50．2） ml比（45．5±52．4） ml]、淋巴结清扫[（10．2±8．4）枚比（12．0±5．6）枚]、术后排气时间[（3．2±0．7） d比（2．8±0．8） d]、开始饮水时间[（4．2±1．1） d比（3．8±0．9） d]、进食半流质时间[（8．6±2．1） d比（8．1±1．7） d]以及住院时间[（13．0±3．4） d比（12．8±7．2） d]的比较，差异均无统计学意义（均P＞0．05）。常规组和减孔组分别出现4例（15．4％）和3例（6．8％）术后并发症（P＝0．233）。结论减孔腹腔镜下高位直肠或乙状结肠癌根治术安全可行，值得进一步推广应用。

Clinical study of reduced-port laparoscopy-assisted resection for cancer at the sigmoid colon and upper rectum

Objective To explore the safety and feasibility of reduced-port laparoscopic-assisted resection for cancer at the sigmoid colon and upper rectum. Methods Clinical data of 70 patients with sigmoid colon or upper rectal cancer undergoing laparoscopic-assisted resection in our department from February 2013 to July 2014 were retrospectively reviewed. Patients were divided into reduced-port group （44 cases, 3 or 4 ports） and conventional group （26 cases, 5 ports）. The operative time, blood loss, retrieved lymph nodes, postoperative exhaust recovery, dietary recovery, hospital stay and morbidity of complication were compared between two the groups. Results No significant differences were observed in operative time [（144.0±40.1） min vs. （115.8±30.8） min], blood loss [（72.9±50.2） ml vs. （45.5± 52.4） ml], number of retrieved lymph nodes [（10.2±8.4） vs. （12.0±5.6）], time to bowel function return [（3.2 ±0.7） d vs. （2.8 ±0.8） d], time to liquid diet [（4.2 ±1.1） d vs. （3.8 ±0.9） d], time to semisolid diet [（8.6 ±2.1） d vs （8.1 ±1.7） d], and postoperative hospital stay [（13.0 ±3.4） d vs. （12.8 ±7.2） d] between two groups （all P〉0.05）. Complication rate of conventional group and the reduced-port group was 15.4% and 7.2% without significant difference （P=0.233）. Conclusions For cancer at the sigmoid colon and upper rectum , reduced-port laparoscopic surgery is feasible , safe and radical as the five-port in terms of technical and oncologic issues. These two procedures have the same short-term outcome.