【摘要】 目的探讨单孔加一孔腹腔镜手术联合ERAS治疗高位直肠及乙状结肠癌的近期疗效。方法回顾性分析2017年11月至2018年10月在福建省肿瘤医院胃肠肿瘤外科进行加速康复外科干预的92例高位直肠及乙状结肠癌患者资料,根据手术方式的不同,分为单孔加一孔手术联合快速康复外科组39例及常规腹腔镜手术联合ERAS组53例,对比两组围术期情况。结果两组患者基线资料无明显统计学差异(P> 0.05),且在手术时间、出血量、上下切缘、清扫淋巴结数量及并发症方面无明显统计学差异(P> 0.05)。但单孔加一孔手术联合ERAS组较常规手术联合ERAS组,总切口长度更短[(6.7±1.1)cm比(8.5±1.3)cm,P=0.000],术后首次下床时间更早[(22.2±5.2)h比(27.1±7.9)h,P=0.001],首次排便时间更早[(70.2±19.8)h比(83.1±20.4)h,P=0.005],术后第一天C反应蛋白值更低[(43.5±28.6)mg/L比(57.2±33.2)mg/L,P=0.038],术后住院时间更短[(7.0±1.7)d比(8.1±2.1)d,P=0.010],且术后2～4天疼痛评分更低(P <0.05)。结论经验丰富的腔镜医师采用单孔加一孔手术治疗高位直肠及乙状结肠癌并联合ERAS干预是安全可行的,且单孔加一孔手术可减低操作难度,具有疼痛轻、术后恢复快等优势,值得临床推广。更多还原

【Abstract】 Objective To evaluate the efficacy of single-incision plus one port laparoscopic surgery(SILS+1) combined with enhanced recovery after surgery(ERAS) for upper rectal and sigmoid colon cancer. Methods A retrospective analysis on 92 cases of upper rectal and sigmoid colon cancer patients who were undergone enhanced recovery after surgery was performed. According to the different operation methods, they were divided into two groups, SILS+1 combined with ERAS group(39 patients) and conventional laparoscopic surgery(CLS) combined with ERAS group(53 patients). Then the perioperative data would be compared. Results The two groups were well balanced with respect to the baseline characteristics(P>0.05). There were no significant difference in operating time, bleeding, resection margin, number of retrieved lymph nodes and morbidity(P>0.05). However, as compared to the CLSERAS group, patients in SILS+1-ERAS group had a smaller incision [(6.7±1.1)cm vs.(8.5±1.3)cm, P=0.000], shorter time to first ambulation [(22.2±5.2)h vs.(27.1±7.9)h, P=0.001], shorter time of bowel movement [(70.2±19.8)h vs.(83.1±20.4)h, P=0.005], lower C-reaction protein in the first day [(43.5±28.6)mg/L vs.(57.2±33.2)mg/L, P=0.038] and shorter time of postoperative hospital stay[(7.0±1.7)d vs.(8.1±2.1)d, P=0.010]. Moreover, the visual analogue scale(VAS) scores were lower from 2 to 4 days after operation in SILS+1-ERAS group(P<0.05). Conclusions For experienced laparoscopic surgeons, it is safe and reproducible in single-incision plus one port laparoscopic surgery combined with ERAS for upper rectal and sigmoid colon cancer. The technical of SILS+1 could reduce the difficulty of operation and postoperative pain, promote postoperative rehabilitation. So it is worthy of clinical promotion.更多还原