| Background: On the basis of relieving the diseases of the patients，pursuing the effect of as much as possible beauty has become the direction ofthe development of modern surgery with the development of times. NaturalOrifice Transluminal Endoscopic Surgery (NOTES) comes into being in thiscontext. this technique has many advantages such as reducing or hiding thesurgery scar, relieving post-operative pain, and promoting the postoperativerehabilitation. Due to some technical difficulties and ethical restrictions, thereal NOTES is still in the research stage. As a product of the intermediate stagethrough the NOTES, the Single Incision Laparoscopic Surgery (SILS) is mostfeasible at this stage through the NOTES. It can take advantage of theumbilicus, the natural channel forms during embryonic period,to do theoperation. This will not only hide the abdominal scar and avoid the infectioncaused by stomach, vagina or rectum, but aiso use traditional laparoscopicinstruments during surgery.Objective: The single incision laparoscopic resection of sigmoid coloncancer and upper rectum cancer still has some issues not yet conclusive.According to some related issues,We will do a retrospective study tosummarize the indications and the safety, feasibility and radical aspects of thistechnique.Methods: First Hospital of Jilin University has30cases of single incisionlaparoscopic resection of sigmoid colon cancer and upper rectum cancer inpatients during the whole2011. For the sake of preoperative diagnosis of livermetastasis, radical surgery can not be operate in2cases, there are28cases ofradical resection of sigmoid colon cancer and upper rectum cancer.34cases of traditional laparoscopic radical resection of sigmoid colon cancer and upperrectum cancer in patients were operated in the same period. The clinical data ofthe2groups will be analyzed retrospectively.Results: There are27cases of successful cases in the whole28SIRRgroup. Because of heavy adhesions and disappearance of the structure of thenormal anatomy,1case belongs to SIRR group is difficult to operate underlaparoscopie and has to change into open surgery.In SIRR group and TRRgroup, the average operative time is (117.78±11.90) min and (145.85±19.89)min (P<0.05), the mean intraoperative blood loss was (64.81±24.18) ml and(40.59±18.74) ml (P>0.05), the number of indwelling drainage tube,respectively (0.37±0.21) of gold and gold (1.82±0.13)(P<0.05). The averageoperative time of TRR group was longer than SIRR group, a significantdifference is between the two groups; there is no significant difference betweentwo groups of intraoperative blood loss; the TRR indwelling drainage tubemore than the number of SIRR and there is a significant difference between thetwo groups. In SIRR group and TRR group,the time of Postoperative isrespectively (2.63±0.47) days (3.03±0.30) days (P>0.05), the time of firstdefecation is (4.44±0.93) days (5.38±0.60) days (P>0.05), the days ofpostoperative hospital stay is (10.48±2.42) days (9.71±1.42) days (P>0.05),average frequency of the use of analgesics is (0.56±0.42) and (0.91±0.76)(P>0.05). There are no statistically differences.5cases of patients in the whole27SIRR group have complications, including4cases of wound infection and1case of abdominal hemorrhage.6cases of patients in the whole28TRR grouphave complications, including5cases of wound infection and1case ofanastomotic leakage. Complications are improved after conservative treatment.There are no statistically differences.The average number of lymph nodedissection of the two groups is (15.85±3.13) and (13.88±2.30)(P>0.05), andthe average number of positive lymph node dissection of the two groups is (0.67±0.58) and (0.97±0.56)(P>0.05).The average distance from the proximalresection margin to the tumor is respectively (6.00±0.44) cm and (5.97±0.56)cm (P>0.05), the average distance from the distal margin to the tumor isrespectively (5.00±0.00) cm and (5.06±0.08) cm (P>0.05). There are nostatistically differences.Conclusion: The study between SIRR and TRR shows that:(1) SIRR issafe and feasible.(2) Compared with TRR, SIRR has the same radical effectand some other advantages such as small trauma and aesthetic outlook. For asurgeon with mature technology, sometimes the operative time of SIRR maybeshorter than that of TRR.(3) SIRR should be considered as a relatively newtechnology and there is no reports of bulk of cases, so its indication isinconclusive. For the units just to launch this technology, we recommendindications of the patients to be studied as follows:①The patients can haveelective surgery;②Age should not be too large;③Height body mass index(BMI) should be appropriate;④No complex comorbidities and otherconcurrent⑤The preoperative diagnosis of cancer disease is clear, lesionsshould be located at least above the junction of sigmoid colon and rectum;⑥For the operater to carry out such surgery, one should control the anatomicalstructure of the corresponding region and the experience of both open andlaparoscopic surgeries in order to have the ability to change into open surgery ifnecessary. |
PDF Full Text Request