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目的:探讨手助腹腔镜(HALS)经腹直肠癌切除术的效益与风险。方法:选择南昌大学第一附属医院2013年1月—2013年7月住院的直肠癌患者50例,按入院后手术顺序先后随机分为HALS组(24例)和腹腔镜辅助(LAS)组(26例),比较两组的手术时间、术中出血量、淋巴结清扫数、中转开腹数、术后肛门首次排气时间、术后并发症、术后住院时间及住院总费用,随访患者术后2年内生活质量评分、肛门不适例数、肿瘤复发数及病死率。结果:手辅助腹腔镜及腹腔镜两组在术中出血量、淋巴结清扫数、术后肛门排气时间、术后并发症、术后2年内肿瘤复发数及病死率均无统计学差异(P>0.05),两组在手术时间、中转开腹数、术后住院时间、住院费用、术后2年生活质量评分及肛门不适数方面HALS组均优于LAS组(P<0.05)。结论:与LAS下经腹直肠癌切除术相比,HALS术在缩短手术及术后住院时间、减少中转开腹率、降低住院费用、提高患者术后生活质量等方面具有明显效益,同时可以达到LAS术同样肿瘤根治效果。
Objective: To explore the benefits and risks of resection of abdominal parathyroidectomy with hand-assisted laparoscopy (HALS). Methods: 50 patients with rectal cancer admitted to the First Affiliated Hospital of Nanchang University from January 2013 to July 2013 were randomly divided into HALS group (24 cases) and laparoscopic assistant group (LAS group) according to the operation sequence after admission 26 cases). The operation time, intraoperative blood loss, number of lymph node dissection, number of laparotomy in laparotomy, the time of the first postoperative anal exhaust, postoperative complications, postoperative hospital stay and hospitalization costs were compared. Patients were followed up Quality of life after 2 years score, anal discomfort number, the number of tumor recurrence and mortality. Results: There was no significant difference in hand-assisted laparoscopic and laparoscopic group in the amount of bleeding, number of lymph node dissection, postoperative anal exhaust time, postoperative complications, tumor recurrence and mortality within 2 years after operation (P > 0.05). The HALS group was superior to LAS group in operation time, number of open laparotomy, postoperative hospital stay, hospitalization cost, postoperative 2-year quality of life score and anus discomfort (P <0.05). CONCLUSIONS: Compared with resection of abdominal rectal cancer under LAS, HALS has obvious benefits in shortening the postoperative hospital stay, reducing the rate of laparotomy, reducing the cost of hospitalization and improving the postoperative quality of life. At the same time, it can achieve LAS surgery the same tumor radical effect.