经肛拖出式全腹腔镜直肠前切除术在中低位直肠癌中的应用体会
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摘要
目的观察经肛拖出式全腹腔镜直肠前切除术在中低位直肠癌中的手术相关指标及并发症发生情况。方法选取2014年3月至2016年4月本院收治的100例中低位直肠癌患者为研究对象,随机分为观察组和对照组,每组各50例。观察组采用经肛拖出式全腹腔镜前切除术,对照组采取腹腔镜辅助直肠前切除术。比较两组手术时间、手术费用、术中出血量、肛门排气时间、清扫淋巴结个数以及并发症发生情况。结果观察组住院时间、手术费用、术中出血量、肛门排气时间均显著少于对照组,观察组清扫淋巴结个数显著多于对照组,差异均有统计学意义(均P<0.05)。观察组与对照组并发症总发生率分别为4.00%、10.00%,差异无统计学意义(P>0.05)。结论与腹腔镜辅助直肠前切除术相比,经拖出式全腹腔镜下直肠前切除术治疗中低位直肠癌手术相关指标总体情况更优,且未增加术后并发症发生率。
Objective To study the safety and efficacy of transanal pull through laparoscopic rectal resection in low rectal carcinoma.Methods 100 patients with middle and lower rectal cancer patients who received treatment in our hospital from March 2014 to April2016 were selected. Using a random number table method, patients were divided into treatment group(50 cases) and control group(50 cases). Patients in the control group received laparoscopic assisted rectal anterior resection, and patients in the treatment group received transanal pull type total laparoscopic anterior resection. We compared between the two groups operation time, operation cost,intraoperative bleeding volume, anal exhaust time, lymph node number and the incidence of complications. Results The hospitalization time, operation cost in the treatment group was lower than those in the control group(P < 0.05). Intraoperative bleeding, anal exhaust time in the treatment group was significantly lower than those in the control group and number of lymph node dissection was greater than that in the control group(P < 0.05). The incidence of complication was significantly different between the two groups(P < 0.05).Conclusion Transanal pull through laparoscopic rectal resection in the treatment of low rectal cancer has advantages of low cost operation time and operation through, and resulted in more lymph node dissection, fewer complications.
Objective To study the safety and efficacy of transanal pull through laparoscopic rectal resection in low rectal carcinoma.Methods 100 patients with middle and lower rectal cancer patients who received treatment in our hospital from March 2014 to April2016 were selected. Using a random number table method, patients were divided into treatment group(50 cases) and control group(50 cases). Patients in the control group received laparoscopic assisted rectal anterior resection, and patients in the treatment group received transanal pull type total laparoscopic anterior resection. We compared between the two groups operation time, operation cost,intraoperative bleeding volume, anal exhaust time, lymph node number and the incidence of complications. Results The hospitalization time, operation cost in the treatment group was lower than those in the control group(P < 0.05). Intraoperative bleeding, anal exhaust time in the treatment group was significantly lower than those in the control group and number of lymph node dissection was greater than that in the control group(P < 0.05). The incidence of complication was significantly different between the two groups(P < 0.05).Conclusion Transanal pull through laparoscopic rectal resection in the treatment of low rectal cancer has advantages of low cost operation time and operation through, and resulted in more lymph node dissection, fewer complications.
引文
[1]王银中,韩朝阳,张艳萍.腹腔镜手术治疗中低位直肠癌的疗效分析[J].中国内镜杂志,2016,22(7):31-34.
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[8]苏洋,吴硕东,孔静,等.单孔腹腔镜低位直肠癌保肛手术5例经验[J].中华普外科手术学杂志:电子版,2012,06(1):16-18.
[9]HIRANYAKAS A,HO YH.Laparoscopic ultralow anterior resection versus laparoscopic pull-through with coloanal anastomosis for rectal cancers:a comparative study[J].Am JSurg,2011,202(3):291-297.
[10]FUJII S,ISHIBE A,OTA M,et al.Short-term results of a random-ized study between laparoscopic and open surgery in elderly color-ectal cancer patients[J].Surg Endosc,2014,28(2):466-76.
[11]ZONG L,CHEN P,KITANO S,et al.Clinical experience and analysisof laparoscopic total mesorectal excision combined with improved Bacon for the treatment of lower rectal cancer[J].Hepatogastroenterology,2011,58(110-111):1538-1544.
[12]李正刚,朱志强,张善家,等.经肛门拖出式吻合技术在腹腔镜低位直肠癌保肛手术中的应用[J].安徽医科大学学报,2012,47(5):588-590.
[13]虞卫新,王勇,孙跃明.腹腔镜与开腹直肠前切除术术后近期疗效的对比分析[J].腹腔镜外科杂志,2013(1):21-24.
[14]GUNKA I,DOSTALIK J,MARTINEK L,et al.Long-term results of laparoscopic versus open surgery for nonmetastatic colorectal cancer[J].Acta Chirurgica Belgica,2012,112(2):139-147.
[15]KANG H,KIM HG,JU JK,et al.Multivisceral resection for locally advanced rectal cancer:adequate length of distal resection margin[J].JKorean Surg Soc,2012,82(2):87-93.
[2]MARQUARDT C,KOPPES P,WEIMANN D,et al.Laparoscopic ultralow anterior rectal resection in APPEAR technique for deep rectal cancer[J].Int J Colorectal Dis,2012,27(4):549-552.
[3]TRASTULLI S,CIROCCHI R,LISTORTI C,et al.Laparoscopic vs open resectionfor rectal cancer:a meta-analysis of randomized clinical trials[J].Colorectal Dis,2012,14(6):e277-296.
[4]GEZENC,ALTUNTAS YE,KEMENT M,et al.Complete versus partial mobilization of splenic flexure during laparoscopic low anterior resectionfor rectal tumors:a comparative study[J].J Laparoendosc Adv Surg Tech A,2012,22(4):392-396.
[5]宋博,刘超,郑阳春,等.术前肠道支架置入联合腹腔镜直肠前切除术治疗中低位梗阻性直肠癌[J].四川医学,2016,07:767-770.
[6]ALLAIX M E,DEGIULI M,GIRAUDO G,et al.Laparoscopic versus open colorectal resections in patients with symptomatic stage IV colorectal cancer[J].Surg Endosc,2012,26(9):2609-16.
[7]IONDOS,KREISLER E,FRACCALVIERI D,et al.Risk factors for surgical siteinfection after elective resection for rectal cancer.A multivariateanalysis on 2131 patients[J].Colorectal Dis,2012,14(3):e95-102.
[8]苏洋,吴硕东,孔静,等.单孔腹腔镜低位直肠癌保肛手术5例经验[J].中华普外科手术学杂志:电子版,2012,06(1):16-18.
[9]HIRANYAKAS A,HO YH.Laparoscopic ultralow anterior resection versus laparoscopic pull-through with coloanal anastomosis for rectal cancers:a comparative study[J].Am JSurg,2011,202(3):291-297.
[10]FUJII S,ISHIBE A,OTA M,et al.Short-term results of a random-ized study between laparoscopic and open surgery in elderly color-ectal cancer patients[J].Surg Endosc,2014,28(2):466-76.
[11]ZONG L,CHEN P,KITANO S,et al.Clinical experience and analysisof laparoscopic total mesorectal excision combined with improved Bacon for the treatment of lower rectal cancer[J].Hepatogastroenterology,2011,58(110-111):1538-1544.
[12]李正刚,朱志强,张善家,等.经肛门拖出式吻合技术在腹腔镜低位直肠癌保肛手术中的应用[J].安徽医科大学学报,2012,47(5):588-590.
[13]虞卫新,王勇,孙跃明.腹腔镜与开腹直肠前切除术术后近期疗效的对比分析[J].腹腔镜外科杂志,2013(1):21-24.
[14]GUNKA I,DOSTALIK J,MARTINEK L,et al.Long-term results of laparoscopic versus open surgery for nonmetastatic colorectal cancer[J].Acta Chirurgica Belgica,2012,112(2):139-147.
[15]KANG H,KIM HG,JU JK,et al.Multivisceral resection for locally advanced rectal cancer:adequate length of distal resection margin[J].JKorean Surg Soc,2012,82(2):87-93.