电凝钩与超声刀在腹腔镜直肠癌根治术中的应用效果对比

摘要

目的 比较电凝钩与超声刀在腹腔镜直肠癌根治术中的应用效果.方法 选取本院2014年10月至2016年10月收治的60例直肠癌患者为研究对象,随机分为观察组与对照组,每组各30例.两组均行腹腔镜直肠癌根治术,观察组采取电凝钩,对照组使用超声刀.比较两组手术相关指标(手术时间、术中出血量、淋巴结清扫数目、远切端阳性率、环周切缘阳性率)、术后恢复情况(术后下床活动时间、住院时间)及医疗花费、并发症总发生率及术后两年的死亡率、局部复发率及转移率.结果 两组手术时间、淋巴结清扫数目、远切端阳性率、环周切缘阳性率的差异均无统计学意义(均P＞ 0.05);观察组术中出血量少于对照组(P＜0.05).两组术后下床活动时间、肛门排气时间、与住院时间的差异均无统计学意义(均P＞0.05);观察组医疗花费明显少于对照组(P＜0.05).两组肠梗阻、吻合口瘘、自主神经相关并发症发生率差异均无统计学意义(均P＞ 0.05),观察组总并发症发生率为6.67％,与对照组的33.33％比较,差异有统计学意义(P＜0.05).随访2年,两组死亡率、局部复发率及转移率均无统计学意义(均P＞ 0.05).结论 与超声刀相比,电凝钩体积小、操作灵活,可减少术中出血量与医疗费用并降低自主神经损伤风险,远期疗效与超声刀辅助腹腔镜直肠癌根治术相当.%Objective To compare the effect of electrocoagulation hook and ultrasonic knife in laparoscopic radical resection of rectal cancer.Methods 60 patients with rectal cancer treated in our hospital from October 2014 to October 2016 were recruited and randomly assigned to the treatment group and the control group,with 30 patients in each group.Both groups received laparoscopic radical resection of rectal cancer.Electric coagulation hook was used in the treatment group and ultrasonic knife was used in the control group.The operation-related indices were compared between the two groups (operation duration,intraoperative blood loss,number of lymph node dissection,the distal incisal edge of the positive rate,the positive rate of circumferential resection margin),postoperative recovery (postoperative ambulation time,hospitalization duration) and medical costs,the total rate of complications and postoperative mortality in two years,local the recurrence rate and metastasis rate were recorded and compared between the two groups.Results There was no significant difference in operation duration,lymph node dissection,distal end positive rate and circumferential margin positive rate between the two groups (P ＞ 0.05).The amount of bleeding was less in the treatment group than that in the control group (P ＜ 0.05).There was no significant difference in time to ambulation,time to anal exhaust and hospitalization duration between the two groups (P＞ 0.05).The cost of medical care was significantly less in the treatment group than that in the control group (P ＜ 0.05).There was no significant difference in the incidence of intestinal obstruction,anastomotic leakage and autonomic nerve-related complications between the two groups (P ＞ 0.05).The total complication rate in the treatment group was 6.67％,which was significantly different from that in the control group (P ＜ 0.05).After 2 years of follow-up,the mortality,local recurrence rate and metastasis rate were not statistically significant between the two groups (all P ＞ 0.05).Conclusion Compared with ultrasonic scalpel,electric coagulation hook is small and flexible for operation,which can reduce intraoperative blood loss and medical cost and reduce the risk of autonomic nerve injury.Meanwhile,long-term effect is comparable with that of ultrasonic knife in laparoscopic radical resection of rectal cancer.