腹腔镜直肠癌直肠全系膜切除保肛手术的临床体会
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摘要
目的探讨腹腔镜下行直肠癌直肠全系膜切除保肛手术的可行性与临床疗效。方法选取2015年1月—2017年12月间该院收治的64例直肠癌患者,随机分为两组,每组32例,观察组实施腹腔镜下TME保肛手术,对照组实施传统开腹手术,比较两组手术学、术后恢复指标与随访结果。结果除手术时间外,观察组手术学指标[术中出血量(52.96±14.55)m L vs(172.34±39.76)mL]与术后恢复指标[肠功能恢复时间(2.11±0.97)d vs(3.89±1.10)d、下床活动时间(5.54±1.27)d vs(8.90±2.31)d]、住院时间[(13.17±2.34)d vs(17.86±3.11)d])均显著优于对照组,差异有统计学意义(P<0.05),随访可知两组复发率(0.00%vs 3.13%,χ~2=0.065)、转移率(3.13%vs 0.00%,χ~2=1.134)与生存率(96.88%vs 100.00%,χ~2=0.706)相近,差异无统计学意义(P>0.05)。结论腹腔镜下行直肠癌直肠全系膜切除保肛手术治疗效果值得肯定,临床应用价值较高。
Objective To investigate the feasibility and clinical efficacy of laparoscopic rectal cancer with total mesorectal excision. Methods 64 patients with rectal cancer admitted to our hospital from January 2015 to December2017 were randomly divided into two groups, 32 patients in each group. The observation group underwent laparoscopic TME anal sphincter operation and the control group underwent traditional open surgery, comparing the surgical and postoperative recovery indicators and follow-up results of the two groups. Results In addition to the operation time, the surgical parameters of the observation group [intraoperative blood loss(52.96±14.55) mL vs(172.34±39.76) mL] and postoperative recovery index [intestinal function recovery time(2.11±0.97)d vs(3.89±1.10)d], time to get out of bed(5.54±1.27)d vs(8.90±2.31)d, hospitalization time(13.17±2.34)d vs(17.86±3.11)d] were significantly better than the control group, the difference was statistically significant(P<0.05). The follow-up rate showed the recurrence rate(0 vs3.13%, χ~2=0.065), metastasis rate(3.13% vs 0.00%, χ~2=1.134) and survival rate(96.88% vs. 100.00%, χ~2=0.706), the difference was not statistically significant(P >0.05). Conclusion The effect of laparoscopic rectal cancer with total mesorectal excision and anal sphincter preservation is worthy of affirmation, and its clinical application value is high.
Objective To investigate the feasibility and clinical efficacy of laparoscopic rectal cancer with total mesorectal excision. Methods 64 patients with rectal cancer admitted to our hospital from January 2015 to December2017 were randomly divided into two groups, 32 patients in each group. The observation group underwent laparoscopic TME anal sphincter operation and the control group underwent traditional open surgery, comparing the surgical and postoperative recovery indicators and follow-up results of the two groups. Results In addition to the operation time, the surgical parameters of the observation group [intraoperative blood loss(52.96±14.55) mL vs(172.34±39.76) mL] and postoperative recovery index [intestinal function recovery time(2.11±0.97)d vs(3.89±1.10)d], time to get out of bed(5.54±1.27)d vs(8.90±2.31)d, hospitalization time(13.17±2.34)d vs(17.86±3.11)d] were significantly better than the control group, the difference was statistically significant(P<0.05). The follow-up rate showed the recurrence rate(0 vs3.13%, χ~2=0.065), metastasis rate(3.13% vs 0.00%, χ~2=1.134) and survival rate(96.88% vs. 100.00%, χ~2=0.706), the difference was not statistically significant(P >0.05). Conclusion The effect of laparoscopic rectal cancer with total mesorectal excision and anal sphincter preservation is worthy of affirmation, and its clinical application value is high.
引文
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[8]江庆斌,陈白丽,文武魁.腹腔镜下全直肠系膜切除联合括约肌切除术治疗超低位直肠癌的临床研究[J].中国内镜杂志,2014,20(12):1289-1292.
[9]邱进.腹腔镜下全直肠系膜切除低位直肠癌保肛手术的临床研究[J].中国实用医药,2015,10(30):80-81.
[10]叶志伟,陈远光,胡明,等.直肠癌经肛内镜全直肠系膜切除术对肛门功能影响的临床研究[J].中国普通外科杂志,2015,24(4):473-477.
[2]王健,王永洪,王依宁,等.腹腔镜中低位直肠癌全直肠系膜切除术的临床分析[J].中华普外科手术学杂志:电子版,2016,10(4):311-314.
[3]蔡栋臣,徐栋,柳旦.腹腔镜与开腹全直肠系膜切除术治疗中低位直肠癌的对比研究[J].腹腔镜外科杂志,2016,21(10):750-754.
[4]阿茹娜.腹腔镜辅助与开腹全直肠系膜切除术在中低位直肠癌保肛患者的疗效比较:一项前瞻性随机试验[J].中国普外基础与临床杂志,2014,21(4):481.
[5]张忠涛,郑民华,姚宏伟,等.直肠癌经肛全直肠系膜切除专家共识及手术操作指南(2017版)[J].中国实用外科杂志,2017,37(9):978-984.
[6]黄彬,黄毅.腹腔镜下全直肠系膜切除术治疗中老年直肠癌的临床疗效及对免疫功能的影响[J].实用临床医药杂志,2017,21(23):31-34.
[7]邢专,谢永灿.腹腔镜下保护盆腔自主神经的全直肠系膜切除术治疗直肠癌患者临床观察[J].外科研究与新技术,2017,6(4):239-241.
[8]江庆斌,陈白丽,文武魁.腹腔镜下全直肠系膜切除联合括约肌切除术治疗超低位直肠癌的临床研究[J].中国内镜杂志,2014,20(12):1289-1292.
[9]邱进.腹腔镜下全直肠系膜切除低位直肠癌保肛手术的临床研究[J].中国实用医药,2015,10(30):80-81.
[10]叶志伟,陈远光,胡明,等.直肠癌经肛内镜全直肠系膜切除术对肛门功能影响的临床研究[J].中国普通外科杂志,2015,24(4):473-477.