腹腔镜下经肛门拖出式前切术对低位直肠癌患者并发症及复发率的影响
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摘要
目的分析腹腔镜下经肛门拖出式前切术对低位直肠癌患者并发症及复发率的影响,为临床治疗提供参考。方法回顾性分析2014年4月至2017年10月期间接受腹腔镜下经肛门拖出式前切术治疗的低位直肠癌患者(观察组,n=80)临床资料,同期腹腔镜下非肛门拖出式前切术治疗的低位直肠癌患者为对照组(对照组,n=80)。数据统计采用SPSS21.0统计软件完成,术中术后计量资料用平均数±标准差表示,两组比较采用独立t检验;术后并发症和复发率比较采用χ~2检验。P<0.05为差异具有统计学意义。结果与对照组相比,观察组病理切缘距离明显增大[对照组(3.0±0.6) cm,观察组(3.9±1.1) cm,P<0.05]、局部复发率明显降低[对照组5.0%,观察组1.3%,P<0.05],而并发症发生率、手术时间、术中出血量、淋巴结清扫数和阳性淋巴结数目之间差异无统计学意义(P>0.05)。结论腹腔镜下经肛门拖出式前切术治疗低位直肠癌简便易行,复发率低。
Objective To observe complications and recurrence of patients with low rectal cancer who underwent laparoscopic transanal pull through anterior resection. Methods From April 2014 to October 2017, clinical data of 80 patients(observation group) with low rectal cancer underwent laparoscopic transanal pull through anterior resection, were analyzed retrospectively. While 80 patients(control group) with low rectal cancer underwent conventional laparoscopic anterior resection. Statistical analysis were performed by using SPSS21.0 software. Postoperative measurement data were expressed as mean±standard deviation, and were examined by independent t-test. The postoperative complications and recurrence rate were expressed as percentage(%), and was examined by chi-square test. A P value<0.05 was considered as significant difference. Results Compared with control group, pathological margin distance increased significantly in observation group [(3.0±0.6) cm vs.(3.9±1.1) cm, P<0.05]. However, the local recurrence rate was significantly lower in observation group(5.0% vs. 1.3%, P<0.05). There were no significant difference between two groups in terms of incidence rate, operation time, intraoperative bleeding, lymph nodes and the number of positive lymph nodes(P>0.05). Conclusion Laparoscopic transanal pull through anterior resection for low rectal cancer is safe and feasible, with lower recurrence rate.
Objective To observe complications and recurrence of patients with low rectal cancer who underwent laparoscopic transanal pull through anterior resection. Methods From April 2014 to October 2017, clinical data of 80 patients(observation group) with low rectal cancer underwent laparoscopic transanal pull through anterior resection, were analyzed retrospectively. While 80 patients(control group) with low rectal cancer underwent conventional laparoscopic anterior resection. Statistical analysis were performed by using SPSS21.0 software. Postoperative measurement data were expressed as mean±standard deviation, and were examined by independent t-test. The postoperative complications and recurrence rate were expressed as percentage(%), and was examined by chi-square test. A P value<0.05 was considered as significant difference. Results Compared with control group, pathological margin distance increased significantly in observation group [(3.0±0.6) cm vs.(3.9±1.1) cm, P<0.05]. However, the local recurrence rate was significantly lower in observation group(5.0% vs. 1.3%, P<0.05). There were no significant difference between two groups in terms of incidence rate, operation time, intraoperative bleeding, lymph nodes and the number of positive lymph nodes(P>0.05). Conclusion Laparoscopic transanal pull through anterior resection for low rectal cancer is safe and feasible, with lower recurrence rate.
引文
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[14] 王申捷,孙晶,陆爱国.直肠癌术后吻合口狭窄的病因分析及治疗进展[J].外科理论与实践,2017,22(2):170-173.
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[3] 孔连广,曹杰智.腹腔镜经腹经肛管内外括约肌间切除术与传统开腹术式在超低位直肠癌保肛治疗中的比较研究[J].岭南现代临床外科,2017,17(6):688-691.
[4] 苏智锋.腹腔镜全直肠系膜切除术对中低位直肠癌老年患者术后胃肠功能及切口感染发生率的影响[J].实用中西医结合临床,2017,17(11):41-42.
[5] 徐海.腹腔镜直肠全系膜切除术对中青年低位直肠癌患者的生活质量和心理状况影响[J].结直肠肛门外科,2017,23(6):753-756.
[6] 贾耀民.腹腔镜经括约肌间切除术对低位直肠癌患者术中出血量及术后肛门排气时间的影响[J].医学理论与实践,2017,30(24):3652-3653.
[7] 张忠涛,杨盈赤.腹腔镜直肠癌根治术难点与争议[J/CD].中华普外科手术学杂志(电子版),2018,12(1):1-4.
[8] 姚宏伟,张忠涛.腹腔镜直肠癌经肛门全直肠系膜切除技巧及疗效评价[J/CD].中华普外科手术学杂志(电子版),2018,12(1):12-14.
[9] 曾国祥.双吻合术预防低位直肠癌术后吻合口漏的临床研究[J].结直肠肛门外科,2016,22(5):509-512.
[10] 陈智,张轲,芮元祎,等.腹腔镜直肠前切除术后吻合口漏发生的危险因素及其防治措施[J/CD].中华结直肠疾病电子杂志,2018,7(2):156-161.
[11] 龚剑峰,韦瑶,顾立立,等.腹腔镜下全结直肠切除、回肠储袋肛管吻合术治疗溃疡性结肠炎38例临床疗效分析[J].中国实用外科杂志,2016,36(4):425-429.
[12] 杨华,胡茂林,肖刚,等.直肠癌前切除术后早期吻合口出血的临床分析[J].腹腔镜外科杂志,2016,21(11):828-831.
[13] 王敏,杨勇,李冲,等.低位直肠癌术中行辅助性造口对吻合口漏发生风险的影响研究[J].结直肠肛门外科,2016,22(2):167-170.
[14] 王申捷,孙晶,陆爱国.直肠癌术后吻合口狭窄的病因分析及治疗进展[J].外科理论与实践,2017,22(2):170-173.