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首页> 外文期刊>International journal of colorectal disease. >Technical difficulty grade score for the laparoscopic approach of rectal cancer: a single institution pilot study.
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Technical difficulty grade score for the laparoscopic approach of rectal cancer: a single institution pilot study.

机译：腹腔镜直肠癌治疗方法的技术难度等级评分：单机构试验研究。

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INTRODUCTION: We aimed to categorize laparoscopic rectal resections according to technical difficulty to standardize learning purposes and stratify results, making future studies more comparable. MATERIALS AND METHODS: Fifty patients undergoing a laparoscopic total mesorectal excision were prospectively followed. Four preoperatively known facts (gender, body mass index (BMI), tumor localization, and preoperative radiation therapy) were compared to four operative outcomes (operation time, blood loss, a visual analogue score (VAS) for difficulty rewarded by the surgeon, and oncological radicality of the procedure). RESULTS: Operating time for male and female patients was 257 vs. 245 min (P=0.229), blood loss was 300 vs. 300 ml (P=0.309), the VAS was 8 vs. 6 (P<0.001), and radicality was 93% vs. 91% (P=0.806). Operating time was 215, 250, and 305 min for high, mid, and low tumors (Spearman -0.44; P=0.02), respectively. Blood loss was 105, 300, and 600 ml (Spearman -0.38; P=0.01). Lower tumors were rewarded a higher VAS (Spearman -0.57; P<0.001) and were less often radically resected (Spearman 0.32; P=0.026). Operating time for irradiated and nonirradiated patients was 277 vs. 225 min (P=0.008), blood loss was 500 vs. 150 ml (P=0.006), the VAS was 7 vs. 5 (P<0.001), and radicality was 79% vs. 100% (P=0.046). Operating time was 240 min for BMI 25-30 and 253 min for BMI>30 (Spearman 0.13; P=0.391). Blood loss was 150 ml for BMI 25-30 and 500 ml for BMI>30 (Spearman 0.38; P=0.01). Higher BMIs were rewarded a higher VAS (Spearman 0.06; P=0.704). BMI had no correlation to radicality of the procedure (Spearman -0.12; P=0.402). There was an association between technical difficulty score and operation time (P=0.007), blood loss (P<0.001), VAS (P<0.001), and radicality of surgery (P=0.043). CONCLUSION: Laparoscopic surgery in male, irradiated, and obese patients with lower tumors seemed more difficult. A categorization according to technical difficulty, to preoperatively predict difficulty of the procedure, was found feasible.
机译：简介：我们旨在根据技术难度对腹腔镜直肠切除术进行分类，以标准化学习目的和分层结果，使未来的研究更具可比性。材料与方法：前瞻性地对50例行腹腔镜全直肠系膜切除术的患者进行随访。将术前已知的四个事实（性别，体重指数（BMI），肿瘤定位和术前放疗）与四个术前结果（手术时间，失血量，视觉模拟评分（VAS），由外科医生奖励的困难以及该程序的肿瘤学根治性）。结果：男性和女性患者的手术时间分别为257分钟和245分钟（P = 0.229），失血量分别为300 vs. 300 ml（P = 0.309），VAS为8 vs. 6（P <0.001）和根治性分别为93％和91％（P = 0.806）。高，中和低肿瘤的手术时间分别为215、250和305分钟（Spearman -0.44; P = 0.02）。失血量分别为105、300和600毫升（Spearman -0.38; P = 0.01）。较低的肿瘤获得较高的VAS（Spearman -0.57; P <0.001），而根治性切除的频率更低（Spearman 0.32; P = 0.026）。接受辐照和未接受辐照的患者的手术时间分别为277和225分钟（P = 0.008），失血为500和150 ml（P = 0.006），VAS为7 vs.5（P <0.001），根治性为79 ％与100％（P = 0.046）。对于BMI 25-30，操作时间为240分钟，对于BMI> 30，操作时间为253分钟（Spearman 0.13; P = 0.391）。 BMI 25-30的失血量为150 ml，BMI> 30的失血量为500 ml（Spearman 0.38; P = 0.01）。 BMI越高，VAS越高（Spearman 0.06; P = 0.704）。 BMI与手术的根本性无关（Spearman -0.12; P = 0.402）。技术难度评分与手术时间（P = 0.007），失血（P <0.001），VAS（P <0.001）和手术的彻底性（P = 0.043）之间存在关联。结论：腹腔镜手术在男性，放射线和肥胖的较低肿瘤患者看来更为困难。发现根据技术难度进行分类，以术前预测手术的难度，是可行的。

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