English  |  正體中文  |  简体中文  |  全文筆數/總筆數 : 45422/58598 (78%)
造訪人次 : 2530168      線上人數 : 235
RC Version 7.0 © Powered By DSPACE, MIT. Enhanced by NTU Library IR team.
搜尋範圍 查詢小技巧：
  • 您可在西文檢索詞彙前後加上"雙引號"，以獲取較精準的檢索結果
  • 若欲以作者姓名搜尋，建議至進階搜尋限定作者欄位，可獲得較完整資料
    •  進階搜尋


    請使用永久網址來引用或連結此文件: http://libir.tmu.edu.tw/handle/987654321/52070


    題名: 直腸癌患者接受機器手臂手術及腹腔鏡手術的比較
    Robotic versus Laparoscopic Surgery for Rectal Cancer
    作者: 陳雅雲
    Chen, Ya-Yun
    關鍵詞: 大腸直腸癌;直腸癌;直腸癌機器手臂手術;大腸癌腹腔鏡手術;直腸癌腹腔鏡手術;機器手臂手術與腹腔鏡手術;Colonrectal cancer;Rectal cancer;Robotic rectal cancer surgery;Laparoscopic colectomy for colon cancer;Laparoscopic rectal cancer surgery;Robotic and laparoscopic surgery
    日期: 2014-06-23
    上傳時間: 2018-10-22 15:05:48 (UTC+8)
    摘要: 論文名稱：直腸癌患者接受機器手臂手術及腹腔鏡手術的比較
    研究所名稱：臺北醫學大學醫務管理學系碩士在職專班
    研究生姓名：陳雅雲
    畢業時間：102學年度第2學期
    指導教授：李顯章 臺北醫學大學醫務管理學系 副教授

    前言
    在大腸直腸癌 ( Colorectal Cancer, CRC ) 患者之中，有40% 的腫瘤是生長在直腸，而直腸癌的局部復發率高，手術治療亦較大腸癌困難，但隨著時代朝流及科技的精進，現今直腸癌的手術治療已有長足的進步。近年來腹腔鏡微創手術蓬勃發展，國內外已有許多大型的臨床試驗及研究證據顯示，大腸癌腫瘤切除手術以腹腔鏡微創手術進行，在術後恢復及腫瘤廓清的手術結果面，都已證實會得到比傳統剖腹手術好的結果及數據，但這些臨床證據並未包含直腸癌患者。對此，國際上已有各國專家們進行更深入的直腸癌腹腔鏡手術與傳統剖腹手術的臨床試驗 ( COLOR II and COREAN trials )，研究結果證明腹腔鏡直腸癌手術比傳統剖腹手術可以達到更完善的目標，在術後恢復會比傳統剖腹手術好。更甚者，目前還有新穎的治療武器：機器手臂手術系統，但運用於直腸癌的手術上，國外目前只有短期研究的結果發表；而國內雖然直腸癌患者眾多，近年來亦已開始運用機器手臂手術系統進行治療，但目前並無與腹腔鏡比較的相關性研究。因此，期望藉此研究，探討直腸癌患者接受腹腔鏡手術與機器手臂微創手術後的手術結果比較，能得到本土性之研究結果，提供臨床醫護人員及患者在治療選擇上之參考。

    研究方法
    本研究採立意取樣法、非雙盲、平行式研究。回溯性收集自2012年01月01日到2014年04月30日之中、低位直腸癌個案共50位，全部個案皆先接受過手術前同步放射、化學治療，在此前導性治療完成後，由醫師會為患者解說機器手臂手術系統及腹腔鏡手術的異同及優缺點，然後依病人意願選擇手術方式，再依其選擇之手術方式分為機器手臂手術一組、腹腔鏡手術一組。所有患者皆由同一手術醫師執行手術。

    研究結果
    兩組患者各有25位個案，在男女性別、年齡、身體質量指數 ( Body Mass Index, BMI )等基本屬性的條件比率相同。研究結果顯示，腫瘤的遠端切緣距離 ( Distal resection margin )及近端切緣距離 ( Proximal resection margin ) 的長度，和腫瘤環週切緣 ( Circumferential resection margin, CRM ) 是否被侵犯，還有淋巴結清除數目之比較皆無顯著差異。唯兩組患者在手術時間上是具有統計上的意義，機器手臂手術組比腹腔鏡手術組的手術時間長。

    結論
    本研究案的研究結果顯示，機器手臂手術組比腹腔鏡手術組的手術時間長，除此之外，機器手臂手術與腹腔鏡手術一樣，可以為直腸癌患者提供同樣安全的腫瘤切除手術，無論是手術後的恢復或腫瘤廓清結果的比較，兩組的結果都無明顯差異。


    關鍵字：大腸直腸癌、直腸癌、直腸癌機器手臂手術、大腸癌腹腔鏡手術、直腸癌腹腔鏡手術、機器手臂手術與腹腔鏡手術

    Title of Thesis: Robotic versus Laparoscopic Surgeryfor Rectal Cancer
    Author: Ya-Yun Chen
    Thesis advised by: Hsien-Chang Li, Ph.D., Professor.

    Introduction:
    Several multi-institutional prospective randomized trials demonstrated that laparoscopic colectomy for colon cancer provided better recovery with comparable oncologic results to open surgery. However, rectal cancer was excluded in previously reported trials. Recently, COLOR II and COREAN trials demonstrated that laparoscopic rectal cancer surgery could be safely performed and it provided better post-operative recovery without compromise of short term oncological results. Laparoscopic surgery for rectal cancer is a technically demanding procedure. Robotic surgery may be a solution for this problem. Only few comparative studies between laparoscopic and robotic rectal cancer surgery were published recently. Robotic rectal surgery was introduced into Taiwan in 2004 but there is still no comparative study between laparoscopic and robotic rectal surgery for rectal cancer. In this study, short term results between these two methods were compared.

    Materials and Methods:
    This is a case matched study with patients operated from Jan. 2012 to Apr. 2014. Potential benefits and drawbacks about robotic and laparoscopic surgery were well explained to patients and their family. Robotic surgery was offered to patients with middle or lower rectal cancer and laparoscopic resection was performed when the patient refused robotic surgery. All patients received pre-operative radiotherapy and all operations were performed by single surgical team.

    Results:
    There were 50 patients with middle or lower rectal cancer and 25 patients received robotic surgery. Gender, age and BMI were matched for both robotic and laparoscopic group. Distance of tumor low margin from anal verge、circumferential resection margin and number of lymph nodes harvested were not significantly different. Operation time is significantly longer in robotic group. However, intra-operative bleeding, post-operative recovery and oncologic results were not significantly different between two methods.

    Conclusion:
    Although operation time was longer, robotic rectal cancer surgery provided same post-operative recovery and short term oncologic results as laparoscopic surgery did even in early experience period.


    Key words：Colonrectal cancer, Rectal cancer, Robotic rectal cancer surgery, Laparoscopic colectomy for colon cancer, Laparoscopic rectal cancer surgery, Robotic and laparoscopic surgery
    描述: 碩士
    指導教授-李顯章
    委員-賴逸儒
    委員-魏柏立
    資料類型: thesis
    顯示於類別:[醫務管理學系暨研究所] 博碩士論文

    文件中的檔案:

    檔案 描述 大小格式瀏覽次數
    index.html0KbHTML325檢視/開啟


    檢視Licence

    在TMUIR中所有的資料項目都受到原著作權保護.

    TAIR相關文章

    著作權聲明 Copyright Notice

    • 本平台之數位內容為臺北醫學大學所收錄之機構典藏，包含體系內各式學術著作及學術產出。秉持開放取用的精神，提供使用者進行資料檢索、下載與取用，惟仍請適度、合理地於合法範圍內使用本平台之內容，以尊重著作權人之權益。商業上之利用，請先取得著作權人之授權。

      The digital content on this platform is part of the Taipei Medical University Institutional Repository, featuring various academic works and outputs from the institution. It offers free access to academic research and public education for non-commercial use. Please use the content appropriately and within legal boundaries to respect copyright owners' rights. For commercial use, please obtain prior authorization from the copyright owner.

    • 瀏覽或使用本平台，視同使用者已完全接受並瞭解聲明中所有規範、中華民國相關法規、一切國際網路規定及使用慣例，並不得為任何不法目的使用TMUIR。

      By utilising the platform, users are deemed to have fully accepted and understood all the regulations set out in the statement, relevant laws of the Republic of China, all international internet regulations, and usage conventions. Furthermore, users must not use TMUIR for any illegal purposes.

    • 本平台盡力防止侵害著作權人之權益。若發現本平台之數位內容有侵害著作權人權益情事者，煩請權利人通知本平台維護人員([email protected])，將立即採取移除該數位著作等補救措施。

      TMUIR is made to protect the interests of copyright owners. If you believe that any material on the website infringes copyright, please contact our staff([email protected]). We will remove the work from the repository.

    Back to Top
    DSpace Software Copyright © 2002-2004  MIT &  Hewlett-Packard  /   Enhanced by   NTU Library IR team Copyright ©   - 回饋