腹腔镜下全直肠系膜切除术与传统直肠癌根治术治疗低位直肠癌的疗效比较
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摘要
目的:观察腹腔镜下全直肠系膜切除术(LTME)与传统直肠癌根治术治疗低位直肠癌的疗效。方法:回顾性分析2013年9月-2017年4月术前经本院病理确诊为原发性低位直肠癌患者198例的临床资料,按照不同手术方法将其分为试验组(LTME)122例和对照组(传统直肠癌根治术)76例。比较两组手术情况、术后情况、并发症、近期疗效、肛门功能情况,分析影响LTME患者术后局部复发的因素。结果:试验组手术时间、病灶与远切缘距离均长于对照组,术中出血量、淋巴结清除数、术后住院、切口愈合、肛门排气时间均少于对照组,比较差异均有统计学意义(P<0.05);试验组并发症发生率为13.11%,低于对照组的19.74%,但比较差异无统计学意义(P>0.05);两组均随访1年,试验组局部复发率均低于对照组(P<0.05),两组生存率、远处转移率、肛门功能Kirwan分级比较,差异均无统计学意义(P>0.05);LTME患者的局部复发主要与肿瘤直径、病灶距肛缘距离、病灶与远切缘距离、分化程度、病理类型、术后放化疗、远处转移等因素有关(P<0.05),且以上因素均为影响直肠癌患者LTME术后局部复发的独立危险因素(P<0.05)。结论:腹腔镜下全直肠系膜切除术在治疗低位直肠癌的操作过程中具有出血少、分离明确、视野清晰的优势,可作为临床治疗低位直肠癌的首选方案。
Objective:To observe the effect of laparoscopic total mesorectal excision(LTME) and conventional rectal cancer radical surgery for low rectal cancer.Method:The clinical data of 198 patients with primary low rectal cancer diagnosed by pathology in our hospital from September 2013 to April 2017 were analyzed retrospectively.According to different surgical methods,they were divided into 122 cases of experimental group(LTME) and 76 cases of control group(traditional rectal cancer radical operation).The operation condition,postoperative condition,complications,short-term curative effect and anal function of two groups were compared,and the factors influencing postoperative local recurrence of LTME patients were analyzed.Result:The operative time,distance between lesion and distant incisal margin in experimental group were longer than those of control group,the intraoperative blood loss,lymph node clearance,hospitalization time,incision healing time and anal exhaust time were less than those of control group,the differences were statistically significant(P<0.05).The incidence of complications in experimental group was 13.11%,lower than 19.74% in control group,but the difference was not statistically significant(P>0.05).They were followed up for 1 year,the local recurrence rate in experimental group was lower than that of control group(P<0.05),and the survival rate,distant metastasis rate and Kirwan classification of anal function between two groups were compared,the difference was not statistically significant(P>0.05).The local recurrence of LTME was mainly related to the diameter of the tumor,the distance from the lesion to the anal margin,the distance between the focus and the distal margin,the degree of differentiation, the pathological type,the postoperative radiotherapy and chemotherapy, and the distant metastasis(P<0.05),and all the above factors were independent risk factors for local recurrence after rectal cancer patients underwent LTME(P<0.05).Conclusion:Laparoscopic total mesorectal excision has the advantages of less bleeding,clear separation and clear vision in treatment of low rectal cancer,can be used as the first choice for clinical treatment of low rectal cancer.
Objective:To observe the effect of laparoscopic total mesorectal excision(LTME) and conventional rectal cancer radical surgery for low rectal cancer.Method:The clinical data of 198 patients with primary low rectal cancer diagnosed by pathology in our hospital from September 2013 to April 2017 were analyzed retrospectively.According to different surgical methods,they were divided into 122 cases of experimental group(LTME) and 76 cases of control group(traditional rectal cancer radical operation).The operation condition,postoperative condition,complications,short-term curative effect and anal function of two groups were compared,and the factors influencing postoperative local recurrence of LTME patients were analyzed.Result:The operative time,distance between lesion and distant incisal margin in experimental group were longer than those of control group,the intraoperative blood loss,lymph node clearance,hospitalization time,incision healing time and anal exhaust time were less than those of control group,the differences were statistically significant(P<0.05).The incidence of complications in experimental group was 13.11%,lower than 19.74% in control group,but the difference was not statistically significant(P>0.05).They were followed up for 1 year,the local recurrence rate in experimental group was lower than that of control group(P<0.05),and the survival rate,distant metastasis rate and Kirwan classification of anal function between two groups were compared,the difference was not statistically significant(P>0.05).The local recurrence of LTME was mainly related to the diameter of the tumor,the distance from the lesion to the anal margin,the distance between the focus and the distal margin,the degree of differentiation, the pathological type,the postoperative radiotherapy and chemotherapy, and the distant metastasis(P<0.05),and all the above factors were independent risk factors for local recurrence after rectal cancer patients underwent LTME(P<0.05).Conclusion:Laparoscopic total mesorectal excision has the advantages of less bleeding,clear separation and clear vision in treatment of low rectal cancer,can be used as the first choice for clinical treatment of low rectal cancer.
引文
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[12]刘国才.对比分析Miles术与保肛术治疗低位直肠癌的临床效果[D].大连:大连医科大学,2015.
[13]徐菁.一项单中心分析:结直肠癌根治术后局部复发的治疗管理和预后效果[J].中国普外基础与临床杂志,2015,22(1):113.
[14]王永亮,赵瑛.直肠癌全系膜切除术[J/OL].中华普通外科学文献(电子版),2011,5(3):188-190.
[15]李想,傅仲学,贾诩.腹腔镜与开腹全直肠系膜切除保肛术治疗低位直肠癌的Meta分析[J].重庆医学,2015,44(12):1658-1661.
[16]刘红光.全直肠系膜切除术与传统手术治疗直肠癌的疗效比较[J].中国现代医生,2017,55(32):36-39.
[17]魏立平.腹腔镜辅助与开腹结直肠癌根治术的临床疗效比较[J].中国实用医药,2016,11(30):15-17.
[18]师阳,常乐,周旭坤,等.腹腔镜与开腹全直肠系膜切除术治疗中低位直肠癌的近期疗效比较[J].中华肿瘤防治杂志,2016,23(S1):145-146.
[19]于俊兰,罗成华,李荣.直肠癌局部复发的手术治疗[J].陕西肿瘤医学,2002(2):152-153.
[20]张金书.直肠癌全直肠系膜切除术后局部复发的相关因素分析[J].实用癌症杂志,2015,30(12):1866-1869.
[2]丁亮.腹腔镜全直肠系膜切除术治疗中低位直肠癌的疗效与安全性观察[J].四川医学,2015,36(6):842-844.
[3]刘亚非.低位直肠癌保肛手术40例临床分析[J].海南医学,2011,22(7):74-75.
[4]李献哲.腹腔镜与开腹直肠癌全直肠系膜切除术治疗直肠癌手术效果比较[J].医药论坛杂志,2016,37(6):90-91.
[5]董保国,谢桂生,梁万强,等.腹腔镜下全直肠系膜切除术治疗低位直肠癌疗效分析[J].浙江临床医学,2014,16(5):739-740.
[6]梁宏伟,陈贵俦,冯石坚.腹腔镜下全直肠系膜切除治疗低位直肠癌的体会[J].岭南现代临床外科,2014,14(1):99-102.
[7]李世拥.实用结直肠癌外科学[M].北京:人民卫生出版社,2012:45.
[8]许力力.全直肠系膜切除术(TME)治疗直肠癌的临床效果观察[J].中国现代药物应用,2014,8(8):63-64.
[9]张慧,查小英.用磷酸钠盐口服液为行结直肠手术的患者进行术前肠道准备的效果观察[J].当代医药论丛,2015,13(14):141-142.
[10]苏旭斌.腹腔镜与开腹直肠癌根治术的近期疗效比较[D].兰州:兰州大学,2016.
[11]杨阳.腹腔镜与开腹ISR治疗低位直肠癌的长期疗效比较[D].上海:第二军医大学,2016.
[12]刘国才.对比分析Miles术与保肛术治疗低位直肠癌的临床效果[D].大连:大连医科大学,2015.
[13]徐菁.一项单中心分析:结直肠癌根治术后局部复发的治疗管理和预后效果[J].中国普外基础与临床杂志,2015,22(1):113.
[14]王永亮,赵瑛.直肠癌全系膜切除术[J/OL].中华普通外科学文献(电子版),2011,5(3):188-190.
[15]李想,傅仲学,贾诩.腹腔镜与开腹全直肠系膜切除保肛术治疗低位直肠癌的Meta分析[J].重庆医学,2015,44(12):1658-1661.
[16]刘红光.全直肠系膜切除术与传统手术治疗直肠癌的疗效比较[J].中国现代医生,2017,55(32):36-39.
[17]魏立平.腹腔镜辅助与开腹结直肠癌根治术的临床疗效比较[J].中国实用医药,2016,11(30):15-17.
[18]师阳,常乐,周旭坤,等.腹腔镜与开腹全直肠系膜切除术治疗中低位直肠癌的近期疗效比较[J].中华肿瘤防治杂志,2016,23(S1):145-146.
[19]于俊兰,罗成华,李荣.直肠癌局部复发的手术治疗[J].陕西肿瘤医学,2002(2):152-153.
[20]张金书.直肠癌全直肠系膜切除术后局部复发的相关因素分析[J].实用癌症杂志,2015,30(12):1866-1869.