Indication Of Three-port Laparoscopy-assisted Low Anterior Resection And Difficulty Analysis

Part one: Indications and operative difficulties of triple-port laparoscopic low anterior resection 1 Objective:Through comparison of TLAR(three-port laparoscopy-assisted low anterior resection)and FLAR(five-port laparoscopy-assisted low anterior resection),the characteristics of patients who are suitable for TLAR and the factors,which have impacts on difficulties of TLAR,are reveled.2 Methods:A retrospective analysis of 81 patients between January 2014 to January 2016 in the department of colorectal surgery of our hospital is conducted for comparing general situation,tumor characteristics,operative condition and rectal MR(R-MR)measurement by univariate and multivariate analysis between triple port group and add port group.The operation time,blood loss,the number of lymph nodes harvest,the lower margin length and the number of complications are enrolled as indicators of the operative difficulties,sample quality and short-term prognosis to explore the factors that would have impact on them.3 Results:Comparing triple-port and add port group,body mass index(BMI)(P = 0.042)and tumor distance from the anal margin(P = 0.020)has significant difference.In rectal MR measurements,diameters N,sagittal diameter of the uterus and sagittal diameter of the prostate has significant difference(P = 0.015;P = 0.023;P <0.01).Diameters(L + N)/(O + P)and tumor transversa diameter has a statistical trend(P = 0.088;P = 0.062).In multivariate analysis,tumor distance from the anal is an independent risk factor(P = 0.023,OR = 0.749,95% Cl = 0.584-0.960).In the surgery-related factors,tumor and peritoneal reflection relationship(P = 0.018)and transverse outlet(P = 0.073)affects the difficulty of operation.Local progress of tumor(P = 0.049),tumor and peritoneal reflection relationship(P = 0.018)and diameter N / L(P = 0.004)affects the quality of surgical specimens.There is no factor found has impact on short-term prognosis.4 ConclusionTLAR has its unique surgical technique and operative difficulties.Preoperative examination,including rectal MR should be performed to assess whether the indication of TLAR have been met.Preoperative evaluation is conducive to draw the right expectations of TLAR.Part two: Estabilshment of follow-up system 1 ObjectiveEstablishment of postoperative follow-up system for colorectal cancer patients facilitates data collection,so as to avoid information loss.2 Methods:Follow-up system is designed for recording,managing and exporting data through Access database software,Visual Basic programming tool and Excel spreadsheet tool.3 Results:The follow-up system is constructed.The clinical data and postoperative follow-up data of the inter-January 2013 to January 2016 colorectal cancer patients is enrolled in the system.4 ConclusionThe follow-up system of colorectal surgery is established,which facilitate the clinical data collection,modification,query and recording.