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  • 學位論文

腹腔鏡與傳統開腹手術切除乙狀直腸癌的手術治療-短期預後比較

Laparoscopic versus Open Resection for Rectosigmoid Carcinoma – The Comparison of Short Term Outcome

指導教授 : 鄭雅文

摘要


前言: 大腸直腸惡性腫瘤已經躍升為台灣整體腫瘤發生率第一名。本研究主要比較以腹腔鏡與傳統開腹手術切除乙狀直腸癌之短期預後。 研究設計: 從西元2009年一月到2012年三月底,患有乙狀結腸癌於中山醫學大學附設醫院大腸直腸外科,接受大腸直腸癌切除手術的患者,由同一個團隊手術及照顧,經由病歷記載做回溯性分析。 研究結果: 經篩選後共有90個病例納入分析,其中腹腔鏡大腸直腸切除組有44個病例而傳統開腹手術組有46個病例。一般性的資料,無論是年齡、性別、麻醉分期、腫瘤大小、病理分期等在兩組間均無統計學上的意義。在短期手術相關預後分析,腹腔鏡組術術後合併症的發生明顯腹腔鏡組少於傳統開腹組(3:12,p=0.022);術中估計出血量(Mean (range)104.6 (25-800):441.9 (100-1425),p<0.01),術中輸血的有無(4:14,p=0.017),術後可接受軟質飲食(定義為每天可食用超過1000公克而且沒有嘔吐)的天數(Median 6(range 4-21):7(range 5-23),p=0.03)、與術後住院天數(Median 10(range 9-36):12(range 7-32),p<0.01)也都呈現腹腔鏡組較佳的趨勢。但在淋巴廓清的數目上(Median 19(range 9-15):24(range 5-59),p=0.03)與手術所花費的時間上(281.4±86.9:208.2±51.7,p<0.01)則明顯為傳統開腹手術有較佳的成果。如果將淋巴廓清的數目再細分成大於等於12顆與小於12顆,則兩組的結果則沒有統計學上的意義(p=0.964)。 結論: 腹腔鏡手術與傳統開腹手術對於乙狀結腸癌的治療,其腫瘤相關預後(oncologic outcome)相似;術後併發症與術後住院天數都是明顯腹腔鏡手術組會優於傳統開腹手術。

並列摘要


Background: Colorectal cancer is the leading cause of cancer incidence in Taiwan. The aim of this study was to compare the short-term outcome between laparoscopic versus and open resection of colorectal cancer patients. Study design: From Jan. 2009 to Mar.2012, patients were pathological proved rectosigmoid malignancy with AJCC staging followed by surgical resection under our service. This was a retrospective chart review study. Results: Ninety colorectal cancer patients who with pathologically confirmed primary colorectal cancer were enrolled in this study. Forty-four were underwent laparoscopic colectomy and 46 were underwent open colectomy. There are no difference between demographic data, ex : age, gender, ASA, tumor size and pathological grading in these two groups. Our results showed that laparoscopic group has less post operative complications(3:12,p=0.022);estimated blood loss(Mean (range) 104.6 (25-800):441.9 (100-1425),p<0.01);and blood transfusion during operation(4:14,p=0.017) compared with open colectomy group. It also has faster post operative recovery like post op tolerance soft diet(definition:try soft diet more than 1000 gm without vomiting)(Median 6,range 4-21):7,range 5-23,p=0.03)and hospital stay (Median 10, range 9-36:12, range 7-32,p<0.01). A similar proportion of patients had a minimum of 12 lymph nodes by pathology (95.7%:95.5%, p=0.946). Conclusion: The oncologic outcome between laparoscopic colectomy and open colectomy is similar. However, there are less complications and hospital stay in laparoscopic colectomy group compared with open colectomy.

參考文獻


行政院衛生署,國民健康局網站
行政院衛生署 國民健康局網站:
Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection
(laparoscopic colectomy). Surg Laparosc Endosc 1991; 1: 144–50
Falk PM, Beart RW, Wexner SD et al. Laparoscopic colectomy: a critical

被引用紀錄


陸懷恩(2013)。老人大腸癌患者接受腹腔鏡大腸切除手術和傳統大腸切除手術臨床結果及醫療資源利用比較〔碩士論文,臺北醫學大學〕。華藝線上圖書館。https://doi.org/10.6831%2fTMU.2013.00041
吳育庭(2016)。腹腔鏡手術與開腹手術於治療大腸癌患者之成本效果分析〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU201600447

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