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ID:36662318
大小:2.01 MB
页数:54页
时间:2019-05-13
《腹腔镜结直肠癌手术的临床和基础研究》由会员上传分享,免费在线阅读,更多相关内容在学术论文-天天文库。
1、上海第二医科大学硕士学位论文腹腔镜结直肠癌手术的临床和基础研究姓名:蔡景理申请学位级别:硕士专业:外科学(普外)指导教师:郑民华2003.5.1腹腔镜结直肠癌手术的临床和基础研究中文摘要目的:比较腹腔镜结直肠癌手术和开腹结直肠癌手术对结直肠癌肿瘤细胞的播散种植的影响。对比腹腔镜和开腹结直肠癌手术的手术疗效,手术根治范围,评估腹腔镜结直肠癌手术的安全有效性。材料和方法:①收集2001年9月一2002年9月上海第二医科大学附属瑞金医院腹腔镜结直肠癌手术36例和开腹结直肠癌手术45例,收集腹腔镜和开腹结直肠癌手术术前,术后腹腔冲洗液lOOml,在腹腔
2、镜组术后用lOOml生理盐水冲洗腹腔镜手术特有器械,离心后,涂片固定染色,观察肿瘤细胞,在手术过程中,建立气腹后通过套管针引出C02气体,经过lOOml生理盐水的滤过后,收集过滤液lOOml,离心后,涂片固定染色,观察肿瘤细胞。②临床部分收集2001年9月一2002年9月瑞金医院腹腔镜结直肠癌手术47例和同期的开腹结直肠癌手术113例。比较手术疗效,术后病理检查和淋巴结清扫情况。结果:①腹腔镜气腹C02气体滤过液中未观察到肿瘤细胞,腹腔镜器械冲洗液发现一例阳性,阳性率为2.78%。腹腔镜组术前腹腔冲洗液中观察到肿瘤细胞的阳性率为33.33%,术
3、后阳性率为8.33%。在开腹组术前腹腔冲洗液阳性率为33.33%,术后阳性率为11.11%。在两种手术方式中无明显差别。②临床资料显示腹腔镜组和开腹组平均手术时rE(152.23±42.57:156.28±41.88分,P=-O.58),术后住院天数(15.02±12.16:17.15±11.80天,2=-0.35),总费用(18741.65±5805.17:18272.67±10263.32元,P=-O.79),平均清扫淋巴结数目(13.70±9.28:12.10±9.74个,P=O.51),肿块切除长度(16.36±6.57:18.40±8
4、.11cm,丹O.17),切缘等均无明显差异,术后进食流质时间(3.55±1.29:5.4612.28天,P5、堂堑茎ThebasicandclinicalresearchofthelaparoscopiecolorectalsurgeryAbstraetPURPOSE:Thepneumoperitoneumandmanipulationofcancerspecimensduringlaparosopiccolectomymayincreaseexfoliationofmalignantcellsintotheperitonealcavity,causingallearlyoccurrenceofperitonealcarcinomatosisorpor6、t.sitesrecurrence.TheaimsofthisstudyweretocomparetheeffectoftumorcelldisseminationandseedingduringcolorectalIaparoscopicsurgeryandconventionalsurgeD'andtocomparetheoutcomesafterlaparoscopicversusopenresectionforcolorectalcancerandtoassessthesafetyandfeasibilkyoflaparoscopics7、urgeryforthecureofcolorectalcancer。METHODS:,@Fromsept200Itosept2002,inthedepartmentofgeneralsurgeryofruijinghospital,intraoperativeperitoneallavagecytologywasperformedin36patients诵逊colorectalcancerduringcoIorectallaparoscopicsurgeryandin45patientswithconventionalsurgery.Cyto8、logywasexaminedtwice,i.e.,immediatelyafteropeningtheperitonealcavityandjust
5、堂堑茎ThebasicandclinicalresearchofthelaparoscopiecolorectalsurgeryAbstraetPURPOSE:Thepneumoperitoneumandmanipulationofcancerspecimensduringlaparosopiccolectomymayincreaseexfoliationofmalignantcellsintotheperitonealcavity,causingallearlyoccurrenceofperitonealcarcinomatosisorpor
6、t.sitesrecurrence.TheaimsofthisstudyweretocomparetheeffectoftumorcelldisseminationandseedingduringcolorectalIaparoscopicsurgeryandconventionalsurgeD'andtocomparetheoutcomesafterlaparoscopicversusopenresectionforcolorectalcancerandtoassessthesafetyandfeasibilkyoflaparoscopics
7、urgeryforthecureofcolorectalcancer。METHODS:,@Fromsept200Itosept2002,inthedepartmentofgeneralsurgeryofruijinghospital,intraoperativeperitoneallavagecytologywasperformedin36patients诵逊colorectalcancerduringcoIorectallaparoscopicsurgeryandin45patientswithconventionalsurgery.Cyto
8、logywasexaminedtwice,i.e.,immediatelyafteropeningtheperitonealcavityandjust
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