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目的探索肥胖对小切口直肠癌低位/超低位前切除术效果的影响,以论证肥胖低位/超低位直肠癌患者行小切口直肠癌切除术的可行性。方法回顾性分析2007年2月至2009年12月期间在四川大学华西医院胃肠外科中心结直肠外科专业组收治且确诊为直肠癌患者的临床资料,根据患者的手术方式,分为小切口组(A组,119例)和标准切口组(B组,188例),同时按照世界卫生组织对肥胖程度的定义,进一步将各组分为超重组和非超重组,比较组内和组间的手术安全性和术后恢复指标。结果在术中出血量方面,A组超重患者的术中出血量高于非超重患者(P=0.018),同时也高于B组中非超重组(P=0.010);在手术持续时间方面,A组的非超重患者的手术持续时间比同组的超重患者短(P=0.016),但比B组非超重患者长(P=0.015);在术后进食方面,A组超重患者,其术后进食时间比B组非超重患者短(P=0.020),而在术后的并发症发生率、肿瘤转移复发率及死亡率方面,4组之间差异均无统计学意义。结论肥胖对于行小切口直肠癌低位/超低位前切除术的操作有一定影响,但也能达到与传统切口手术相同的治疗效果且术后康复安全性较好,在直肠癌专业化手术的基础上,肥胖患者的小切口直肠癌低位/超低位根治术是可行的术式。
Objective To explore the effect of obesity on the effect of low / ultra low resection of small incision rectal cancer in order to demonstrate the feasibility of small incision rectal cancer resection in patients with obesity low / low rectal cancer. Methods The clinical data of patients with colorectal cancer who were admitted to Department of Colorectal Surgery, West China Hospital of Sichuan University from February 2007 to December 2009 were retrospectively analyzed. According to the operation mode, the patients were divided into small incision group (Group A, n = 119) and standard incision group (group B, n = 188). According to WHO’s definition of obesity, each group was further divided into overweight and non-overweight groups. Surgical safety and postoperative recovery indicators. Results In terms of intraoperative blood loss, the amount of intraoperative blood loss in overweight patients in group A was significantly higher than that in non-overweight patients (P = 0.018), and also higher than that in non-overweight patients in group B (P = 0.010). For the duration of surgery, Patients in non-overweight group A had a shorter duration of surgery (P = 0.016) than non-overweight patients in group B (P = 0.015), but those in overweight group A The time after eating was shorter than that of non-overweight patients in group B (P = 0.020), but there was no significant difference in postoperative complication rate, tumor metastasis recurrence rate and mortality rate among the 4 groups. Conclusion Obesity has some influence on the operation of low / ultra low resection for small incision rectal cancer, but it can also achieve the same therapeutic effect as traditional incision surgery and has good postoperative rehabilitation safety. It is the basis of specialized surgery for rectal cancer On the obese patients with small incision rectal cancer low / low radical surgery is feasible.