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目的研究3D腹腔镜系统在结直肠癌根治术中手术操作技术、术后短期疗效、可行性、安全性及肿瘤根治性。方法采用前瞻性分析法,收入2013年11月至2015年6月在上海市微创外科临床医学中心进行腹腔镜结直肠癌根治术的74例病人,按照随机数字表法分为2D(高清)腹腔镜组及3D腹腔镜组。2D腹腔镜组共38例,其中男性20例、女性18例,中位年龄为60.5岁(46~83岁);3D腹腔镜组共36例,其中男性16例、女性20例,中位年龄为62岁(37~84岁)。38例2D腹腔镜组病人中,腔镜右半结肠癌根治术12例,腹腔镜左半结肠癌根治术4例,腹腔镜横结肠癌根治术1例,腹腔镜乙状结肠癌根治术2例,腹腔镜根治性直肠前切除术17例(其中3例行末端回肠造口术),腹腔镜腹会阴联合直肠癌根治术2例。36例3D腹腔镜病人中,腹腔镜右半结肠癌根治术15例,腹腔镜左半结肠癌根治术3例,腹腔镜横结肠癌根治术1例,腹腔镜乙状结肠癌根治术3例,腹腔镜根治性直肠前切除术10例(其中5例行末端回肠造口术),腹腔镜腹会阴联合直肠癌根治术4例。结果所有病例均成功接受手术,无术中严重并发症和手术死亡发生,无中转开腹手术。2D腹腔镜组平均手术时间为(153.3±54.9)min,平均术中出血为(117.9±102.5)ml,平均排气时间为(2.3±0.9)d,平均住院天数为(9.6±7.8)d。3D腹腔镜组平均手术时间为(152.9±48.3)min,与2D腹腔镜组比较P=0.973;平均术中出血为(100.3±66.3)ml,与2D腹腔镜组比较P=0.386;平均排气时间为(2.1±0.8)d,与2D腹腔镜组比较P=0.228;平均住院天数为(8.1±3.2)d,与2D腹腔镜组比较P=0.289。术后2D腹腔镜组有1例腹腔镜根治性直肠前切除术及1例腹腔镜右半结肠癌根治术出现吻合口漏;3D腹腔镜组有1例腹腔镜腹会阴联合直肠癌根治术出现会阴切口感染。以上病人予对症治疗后均好转,无行二次手术病人。结论 2D腹腔镜系统与3D腹腔镜系统在手术操作上相似,两者手术后临床短期疗效、肿瘤根治程度相当。进一步研究尚需病例的积累与远期疗效的观察。
Objective To study the technique of 3D laparoscopic surgery in the treatment of colorectal cancer, the short-term curative effect, feasibility, safety and tumor curative effect. Methods According to the prospective analysis method, 74 patients who underwent laparoscopic radical resection of colorectal cancer at the Minimally Invasive Surgery Clinic in Shanghai from November 2013 to June 2015 were divided into 2D (high definition) Laparoscopic group and 3D laparoscopic group. There were 38 cases in 2D laparoscopic group, including 20 males and 18 females, with a median age of 60.5 years (46-83 years). There were 36 cases in 3D laparoscopic group, including 16 males and 20 females, with median age 62 years old (37-84 years old). Of the 38 cases of 2D laparoscopic group, 12 cases underwent endoscopic colonoscopy with right colon cancer, 4 cases underwent laparoscopic radical resection of the left colon cancer, 1 case underwent laparoscopic radical colonoscopical surgery, 2 cases underwent laparoscopic radical resection of the colon carcinoma, Radical radical rectal resection in 17 cases (3 cases of terminal ileostomy), laparoscopic abdominal perineal rectal cancer radical surgery in 2 cases. Of the 36 cases of 3D laparoscopic patients, laparoscopic right colon cancer radical mastectomy in 15 cases, laparoscopic radical mastectomy in 3 cases, laparoscopic radical mastectomy in 1 case, laparoscopic radical mastectomy in 3 cases, laparoscopy Radical rectal resection in 10 cases (of which 5 cases of distal ileostomy), laparoscopic abdominal perineal rectal cancer in 4 cases. Results All cases were successfully operated on without severe intraoperative complications and surgical death, and no laparotomy was performed. The average operation time of 2D laparoscopic group was (153.3 ± 54.9) min, the average intraoperative bleeding was (117.9 ± 102.5) ml, the average time of extubation was (2.3 ± 0.9) days and the average length of hospital stay was (9.6 ± 7.8) days. The average operation time in 3D laparoscopic group was (152.9 ± 48.3) min, which was significantly lower than that in 2D laparoscopic group (P = 0.973). The mean intraoperative bleeding was (100.3 ± 66.3) ml, P = 0.386 (2.1 ± 0.8) d, P = 0.228 compared with 2D laparoscopic group; the mean length of hospital stay was (8.1 ± 3.2) d, P = 0.289 compared with 2D laparoscopic group. There was anastomotic leakage in 1 case of laparoscopic radical rectal resection and 1 case of laparoscopic right colon cancer in 2D laparoscopic group; 1 case of laparoscopic abdominal perineum combined with radical resection of rectal cancer in 3D laparoscopic group Perineal incision infection. More patients after symptomatic treatment were better, no second surgery patients. Conclusions The 2D laparoscopic system and the 3D laparoscopic system are similar in operation. Both of them have short-term curative effect after operation and have the same radical cure. Further study still need cases of accumulation and long-term efficacy of observation.