经肛拖出式腹腔镜直肠癌前切除术治疗低位直肠癌的临床效果观察
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摘要
目的探讨经肛拖出式腹腔镜直肠癌前切除术治疗低位直肠癌的临床效果。方法纳入2014年3月至2016年3月50例低位直肠癌患者作为研究对象,随机抽签分为观察组与对照组,每组各25例。观察组行经肛门拖出式腹腔镜直肠癌前切除术,对照组行常规腹腔镜直肠癌前切除术。比较两组手术相关指标,术后随访2年观察术后并发症发生情况和生存情况。结果观察组术后首次肛门排气时间及术后住院时间少于对照组,差异有统计学意义(P <0.05),两组手术时间、术中出血量及淋巴结清扫数目比较,差异均无统计学意义(均P> 0.05)。观察组术后并发症发生率低于对照组,两组比较差异有统计学意义(P <0.05)。两组患者术后化疗率比较差异无统计学意义(P> 0.05),术后2年无进展生存率和总生存率比较差异均无统计学意义(Log-rank χ~2=0.519、0.647,P=0.471、0.421)。结论经肛拖出式腹腔镜直肠癌前切除术与常规腹腔镜直肠癌前切除术临床疗效相当,但经肛拖出式腹腔镜直肠癌前切除术有助于减少术后并发症,促进早期康复。
Objectives To investigate the clinical effect of transanal laparoscopic anterior resection of rectal cancer in treating low rectal cancer. Methods Fifty patients with low rectal cancer treated between March 2014 and March 2016 were recruited as study subjects and were randomly assigned to treatment group and control group, with 25 patients in each group. Patients in treatment group received transanal laparoscopic anterior resection and those in the control group received routine laparoscopic anterior resection. Indices related to operation were compared between the two groups. Patients were followed up for two years and incidence of postoperative complications and survival were recorded. Results Time to first anal exhaust and duration of hospitalization after surgery were significantly shorter in the treatment group than in the control group(P < 0.05). There was no significant difference in duration of surgery, amount of intraoperative blood loss and the number of dissected lymph nodes(P > 0.05). Incidence of postoperative complications was significantly lower in the treatment group than in the control group(P < 0.05). Percentage of patients receiving postoperative chemotherapy did not differ between groups(P > 0.05). Two-year progression-free survival and overall survival were similar between groups(Log-rank χ~2= 0.519 and 0.647, respectively, P = 0.471 and 0.421, respectively). Conclusion Transanal laparoscopic anterior resection is comparable to conventional laparoscopic anterior resection in terms of clinical effectiveness, but the former has less postoperative complications, which is beneficial for early recovery.
Objectives To investigate the clinical effect of transanal laparoscopic anterior resection of rectal cancer in treating low rectal cancer. Methods Fifty patients with low rectal cancer treated between March 2014 and March 2016 were recruited as study subjects and were randomly assigned to treatment group and control group, with 25 patients in each group. Patients in treatment group received transanal laparoscopic anterior resection and those in the control group received routine laparoscopic anterior resection. Indices related to operation were compared between the two groups. Patients were followed up for two years and incidence of postoperative complications and survival were recorded. Results Time to first anal exhaust and duration of hospitalization after surgery were significantly shorter in the treatment group than in the control group(P < 0.05). There was no significant difference in duration of surgery, amount of intraoperative blood loss and the number of dissected lymph nodes(P > 0.05). Incidence of postoperative complications was significantly lower in the treatment group than in the control group(P < 0.05). Percentage of patients receiving postoperative chemotherapy did not differ between groups(P > 0.05). Two-year progression-free survival and overall survival were similar between groups(Log-rank χ~2= 0.519 and 0.647, respectively, P = 0.471 and 0.421, respectively). Conclusion Transanal laparoscopic anterior resection is comparable to conventional laparoscopic anterior resection in terms of clinical effectiveness, but the former has less postoperative complications, which is beneficial for early recovery.
引文
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[14]许超宇,王健,吴洌,等.经自然通道保护性取出标本的腹腔镜直肠癌根治术59例的临床研究[J].中国继续医学教育,2015,7(3):33-34.
[15]张永康,张剑,廖晓锋.腹腔镜下直肠经肛门拖出式手术与直肠前切除术治疗低位直肠癌的比较[J].中国微创外科杂志,2016,16(8):736-739.
[2]DENOST Q,ADAM J P,RULLIER A,et al.Perineal transanal approach:a new standard for laparoscopic sphinctersaving resection in low rectal cancer,a randomized trial[J].Annals of Surgery,2014,260(6):993-998.
[3]王道荣,李清国,汤东,等.腹腔镜低位和超低位直肠癌保肛根治术中改良襻式回肠末端造瘘的应用价值[J].中华消化外科杂志,2013,12(5):362-365.
[4]杨威,彭超.改良双吻合术与常规双吻合术在直肠低位前切除术中的应用[J].结直肠肛门外科,2017,23(2):143-146.
[5]施美钦,林平联,林拳平.腹腔镜直肠癌经自然腔道标本取出(NOSE)术的手术配合及体会[J].中国卫生标准管理,2017,8(26):157-159.
[6]林恒军,邱学科,袁航.经肛拖出式全腹腔镜直肠癌前切除在直肠癌患者中的临床价值[J].中国内镜杂志,2017,23(1):1-5.
[7]EDGE S B,BYRD D R,COMPTON C C,et al.AJCC cancer staging manual[M].7thed.New York:Springer,2010.
[8]中华医学会外科学分会腹腔镜与内镜外科学组.腹腔镜结直肠癌根治手术操作指南(2008版)[J].中华胃肠外科杂志,2009,12(3):310-312.
[9]PROVENZALE D,GUPTA S,AHNEN D J,et al.Genetic/Familial high-risk assessment:colorectal version 1.2016,NCCN clinical practice guidelines in oncology[J].Journal of the National Comprehensive Cancer Network Jnccn,2016,14(8):1010.
[10]闫军,李亮.腹腔镜与传统开腹手术治疗直肠癌的安全性及远期疗效比较[J].标记免疫分析与临床,2015,22(2):109-112.
[11]LIU Z,KANG L,HUANG M,et al.Open surgery against laparoscopic surgery for mid-rectal or low-rectal cancer of male patients:better postoperative genital function of laparoscopic surgery[J].Surgical Laparoscopy Endoscopy&Percutaneous Techniques,2015,25(5):444-448.
[12]CHI P,HUANG S H,LIN H M,et al.Laparoscopic transabdominal approach partial intersphincteric resection for low rectal cancer:surgical feasibility and intermediateterm outcome[J].Annals of Surgical Oncology,2015,22(3):1-8.
[13]张宜江.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[J].结直肠肛门外科,2017,23(2):170-173.
[14]许超宇,王健,吴洌,等.经自然通道保护性取出标本的腹腔镜直肠癌根治术59例的临床研究[J].中国继续医学教育,2015,7(3):33-34.
[15]张永康,张剑,廖晓锋.腹腔镜下直肠经肛门拖出式手术与直肠前切除术治疗低位直肠癌的比较[J].中国微创外科杂志,2016,16(8):736-739.