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目的探讨腹腔镜下骶前肿瘤切除术的可行性和安全性。方法回顾性分析2006年3月至2015年12月期间于川北医学院附属医院行腹腔镜骶前肿瘤切除术(n=6)或传统开腹骶前肿瘤切除术(n=43)的49例原发性骶前肿瘤患者的临床资料,比较腹腔镜组和开腹组患者的术中出血量、手术时间、术后肛门排气时间、住院时间、卧床时间、并发症等临床指标。结果所有患者的肿瘤均被完整切除,无一例围手术期死亡。2组患者的术中出血量、术后肛门排气时间、住院时间及卧床时间比较差异均有统计学意义(P<0.05),与开腹组比较,腹腔镜组的术中出血量少,术后肛门排气早,住院时间和卧床时间均较短;但2组患者的手术时间、总并发症发生率、切口并发症发生率、粘连性肠梗阻发生率及肿瘤复发率比较差异均无统计学意义(P>0.05)。出院后所有患者获随访,随访时间6~24个月,中位数为16个月。随访期间开腹组有3例发生肿瘤复发(2例为恶性畸胎瘤,1例为脂肪肉瘤),腹腔镜组患者无一例肿瘤复发。结论与开腹手术相比,腹腔镜下骶前肿瘤切除术具有术中出血少、术后恢复快、住院时间及卧床时间短的优点,腹腔镜下行原发性骶前肿瘤切除术是安全和可行的。
Objective To investigate the feasibility and safety of laparoscopic presacral tumor resection. Methods The clinical data of 49 patients with laparoscopic presacral neoplasia resection (n = 6) or conventional open sacral presacral neoplasm resection (n = 43) from March 2006 to December 2015 in the Affiliated Hospital of North Sichuan Medical College were retrospectively analyzed. The clinical data of patients with primary presacral neoplasia were compared between the laparoscopic group and open group patients with intraoperative blood loss, operation time, postoperative anal exhaust time, hospital stay, bed time, complications and other clinical indicators. Results All the patients’ tumors were completely resected, and no perioperative death was found. There was significant difference between the two groups in the amount of blood loss, anal exhaust time, hospital stay and bed time (P <0.05). Compared with the open group, laparoscopic group had less intraoperative blood loss, There was no significant difference between the two groups in terms of operation time, total complication rate, incision complication rate, incidence of adhesive intestinal obstruction and tumor recurrence rate Statistical significance (P> 0.05). All patients were followed up after discharge from 6 to 24 months with a median of 16 months. During the follow-up period, there were 3 cases of tumor recurrence in laparotomy group (2 cases of malignant teratoma, 1 case of liposarcoma), and none of patients in laparoscopic group had tumor recurrence. Conclusions Laparoscopic presacral neoplasm resection has the advantages of less intraoperative bleeding, faster recovery after surgery, shorter hospital stay and bed stay than laparotomy. Laparoscopic primary presacral neoplasia resection is safe and effective feasible.