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Two-stage Treatment with Hybrid2-port Hand-assisted Laparoscopic Surgery for Complete Bowel Obstruction by Left Colon Cancer or Rectal Cancer

Author: WuKun
Tutor: ZhangJiangNan
School:
Course: Surgery
Keywords: hand-assisted laparoscopic surgery(HALS) left hemicolectomy temporary loop colostomy obstructing left-sided colonic carcinoma
CLC: R735.3
Type: Master's thesis
Year: 2013
Downloads: 11
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Abstract


Objective:This study aimed to evaluate the feasibility and safety of emergency temporaryloop colostomy (TLC)10-14days after hand-assisted laparoscopic surgery (HALS)left hemicolectomy for obstruced left-sided colonic carcinoma and to compare itsoperative and short-term clinical outcomes with the open approach.Methods:Between August2009and December2012,40consecutive patients withobstructing left-sided colonic carcinoma underwent emergency left hemicolectomy atour institution,20with temporary loop colostomy after hand-assisted laparoscopicapproach and20with the open approach. Clinical data were retrospectively collectedand compared between the two groups.Results:1. Preoperative indicators: there is no significant difference (P>0.05) orstatistical difference between the two groups in age, gender, history of previoussurgery, obstruction time and TNM staging.2. Compare the results of surgery clinical:40cases of acute obstructive leftcolonic cancer or rectal cancer resection are all successful. Average intraoperativeblood loss in the HALS group is15.0ml and147.1ml, laparotomy group is251.2mland110.5ml, and the intraoperative blood loss in the hand assisted laparoscopic(TLC-HALS) group is obvious less than the laparotomy group (P <0.05). The handassisted laparoscopic (TCL-HALS) group has significant advantage on the aspect ofpostoperative ambulation time. The postoperative ambulation time of the handassisted laparoscopic (TLC-HALS) group is earlier than laparotomy group (P<0.05).The incision lengths of the two groups have significant difference: average length ofthe hand assisted laparoscopic (TLC-HALS) group is6.5cm, and the laparotomygroup has two incisions–17.8cm and8.2cm. The tumor sizes and the quantity ofcleaned lymph nodes is no significant difference in two groups (P>0.05) and there is no statistical significance. But the surgery duration time of the hand assistedlaparoscopic (TLC-HALS) group is longer than the laparotomy group.3. Compare the results of postoperative complications: the postoperativecomplications of the hand assisted laparoscopic (TCL-HALS) group include2case ofpulmonary infection and4cases of incision infection. The laparotomy group has7cases of postoperative complications including2cases of incision infection,1casesof pulmonary infection,1case of urinary tract infection,2cases of urinary retention,and1case of anastomotic leakage. But the statistical analysis shows that there is nostatistical significance between two groups (P>0.05)Conclusion:Emergency laparoscopic-assisted left hemicolectomy can be safely performed inpatients with obstructing left-sided colonic carcinoma. Compared with the openapproach, the temporary loop colostomy10-14days after hand-assisted laparoscopicapproach is associated with less blood loss, shorter incision,needless to use the analbag and earlier ambulation.

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