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目的比较腹腔镜辅助与开腹直肠癌Miles根治术对会阴部伤口愈合的影响。方法收集2008年1月至2009年12月期间我院行腹腔镜Miles根治术的54例(腹腔镜组)及行开腹Miles根治术的48例(开腹组)直肠癌患者的临床资料,比较2组患者会阴部伤口的甲级愈合率、全程手术时间、会阴部手术时间、术中出血量、术后骶前引流量及术后第3天血白蛋白水平的差异。结果 2组患者在性别、年龄、肿瘤Dukes分期、术前白蛋白水平及术前合并症方面差异均无统计学意义(P>0.05)。腹腔镜组的会阴部伤口甲级愈合率(2χ=5.54,P<0.05)及术后第3天血白蛋白水平(t=3.92,P<0.01)均明显高于开腹组。腹腔镜组会阴部手术时间(t=6.64,P<0.01)、术中出血量(t=6.05,P<0.01)和术后骶前引流量(t=12.86,P<0.01)均明显短于或少于开腹组。结论腹腔镜辅助Miles根治术较开腹Miles手术具有更高的会阴部伤口甲级愈合率,这可能与腹腔镜手术创伤小、出血少及会阴部手术时间更短有关。
Objective To compare the effect of laparoscopic assisted and open radical Miles radical surgery on perineal wound healing. Methods Clinical data of 54 patients with laparoscopic Miles laparoscopic surgery (laparoscopic group) and 48 patients with laparoscopic Miles radical operation (open surgery group) from January 2008 to December 2009 were collected. The difference in grade A healing rate, total operative time, perineal operative time, intraoperative blood loss, postoperative fistula drainage volume, and serum albumin level at postoperative day 3 were compared between the two groups of patients. Results There was no significant difference in gender, age, tumor Dukes stage, preoperative albumin level and preoperative complications between the two groups (P>0.05). In the laparoscopic group, perineal wound healing rate of grade A (2χ=5.54, P<0.05) and serum albumin level (t=3.92, P<0.01) on the third day after operation were significantly higher than those in the open group. The laparoscopic group had shorter perineum surgery time (t=6.64, P<0.01), intraoperative blood loss (t=6.05, P<0.01) and postoperative anterior fistula drainage (t=12.86, P<0.01). Or less than open group. [Conclusions] The laparoscopically assisted Miles radical surgery has a higher percutaneous healing rate of the perineal wound than the open Miles, which may be related to the less trauma, less bleeding, and shorter operation time of the perineum in laparoscopic surgery.