腹腔镜下全直肠系膜切除术联合经肛门内括约肌间切除术治疗超低位直肠癌的效果分析
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摘要
目的研究腹腔镜全直肠系膜切除术(TME)联合经肛门内括约肌间切除术(ISR)治疗超低位直肠癌的效果。方法回顾性分析2011年1月至2015年1月于我院进行手术治疗的60例超低位直肠癌患者临床资料,根据手术方法分为腹腔镜组(n=25)与开腹组(n=35),观察比较两组治疗效果。结果与开腹组比较,腹腔镜组手术时间显著延长(P <0. 05),但术中出血量及出院时间显著减少/缩短(P <0. 05);腹腔镜组和开腹组并发症发生率分别为8. 00%和28. 57%(P <0. 05);术后6个月,两组Williams分级、肛管测压结果差异均无统计学意义(P> 0. 05),但腹腔镜组生活质量显著高于开腹组(P <0. 05);随访3年,两组局部复发率、远处转移率及生存率无统计学意义(P> 0. 05)。结论腹腔镜下TME联合ISR治疗低位直肠癌具有微创优势,其效果与开腹手术相似。
Objective To investigate the effects of laparoscopic total mesorectal excision( TME) combined with intersphincteric resection( ISR) in the treatment of ultra-low rectal cancer.Methods The clinical data of 60 patients with ultra-low rectal cancer who underwent surgery in our hospital from January 2011 to January 2015 were retrospectively analyzed.According to the surgical methods,the patients were divided into laparoscopic group( n = 25) and open group( n = 35).The treatment effects were compared between the two groups.Results Compared with the open group,the operative time in laparoscopic group was significantly prolonged,but the intraoperative blood loss and discharge time were significantly reduced or shortened( P < 0. 05).The incidence of complications in the laparoscopic group and the open group were 8. 00% and 28. 57% respectively( P < 0. 05).At 6 months after operation,there were no significant differences in the Williams grading and anal pressure between the two groups( P > 0. 05),but the quality of life in the laparoscopic group was significantly higher than that in the open group( P < 0. 05).After 3 years of follow-up,there were no significant differences in the local recurrence rate,distant metastasis rate and survival rate between the two groups( P > 0. 05).Conclusion Laparoscopic TME combined with ISR for ultra-low rectal cancer has minimally invasive advantages,and its effects are similar to open surgery.
Objective To investigate the effects of laparoscopic total mesorectal excision( TME) combined with intersphincteric resection( ISR) in the treatment of ultra-low rectal cancer.Methods The clinical data of 60 patients with ultra-low rectal cancer who underwent surgery in our hospital from January 2011 to January 2015 were retrospectively analyzed.According to the surgical methods,the patients were divided into laparoscopic group( n = 25) and open group( n = 35).The treatment effects were compared between the two groups.Results Compared with the open group,the operative time in laparoscopic group was significantly prolonged,but the intraoperative blood loss and discharge time were significantly reduced or shortened( P < 0. 05).The incidence of complications in the laparoscopic group and the open group were 8. 00% and 28. 57% respectively( P < 0. 05).At 6 months after operation,there were no significant differences in the Williams grading and anal pressure between the two groups( P > 0. 05),but the quality of life in the laparoscopic group was significantly higher than that in the open group( P < 0. 05).After 3 years of follow-up,there were no significant differences in the local recurrence rate,distant metastasis rate and survival rate between the two groups( P > 0. 05).Conclusion Laparoscopic TME combined with ISR for ultra-low rectal cancer has minimally invasive advantages,and its effects are similar to open surgery.
引文
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[9]沈晓明,刘如钱,鲍传庆.腹腔镜下全直肠系膜切除术联合经肛管括约肌间切除术在超低位直肠癌保肛手术中的应用效果分析[J].实用临床医药杂志,2017,21(17):131-132.
[10]方复,卢国春,毛华辉.腹腔镜全系膜切除术联合经肛门内括约肌切除术治疗超低位直肠癌的疗效分析[J].中华全科医学,2017,15(4):724-726.
[11]王振军.内括约肌切除术治疗超低位直肠癌的进展和新问题[J].临床外科杂志,2017,25(4):251-254.
[12]韩寅,何勇,黄进.腹腔镜全直肠系膜切除术治疗老年中低位直肠癌的近期疗效及安全性评价[J].海南医学,2017,28(5):749-751.
[13]董博,黄博,董永红,等.腹腔镜与开腹全直肠系膜切除术治疗直肠癌的临床比较[J].肿瘤研究与临床,2016,28(10):679-682.
[2]张斌,赵克,刘泉龙,尹淑慧,赵玉涓,卓光鑚,冯滢滢,朱军,丁健华.低位直肠癌腹腔镜经括约肌间切除术后并发症及其处理[J].中华胃肠外科杂志,2017,20(4):432-438.
[3]池畔.膜解剖指导下的腹腔镜全直肠系膜切除术[J].华胃肠外科杂志,2016,19(10):1088-1091.
[4]张志鹏,姚宏伟,陈宁,等.腹腔镜辅助经肛门全直肠系膜切除术治疗中低位直肠癌的临床疗效[J].中华消化外科杂志,2017,16(7):695-700.
[5]Schuebel E,Chen W,Cope L,et al.Comparing the DNA hypermethylome with gene mutations in human colorectal cancer[J].Plos Genetics,2016,3(9):1709-1723.
[6]徐辉,张汝一,姬清华,等.低位直肠癌保肛术行回肠造口与单做保肛术的疗效比较[J].广东医学,2017,38(7):1082-1084.
[7]Van Cutsem E,Cervantes A,Adam R,et al.ESMO consensus guidelines for the management of patients with metastatic colorectal cancer[J].Annals of Oncology,2016,27(8):1386-1422.
[8]钟邦华,李昱骥,孔凡民.直肠癌患者腹腔镜下全直肠系膜切除术疗效分析[J].中国医科大学学报,2017,46(8):739-741.
[9]沈晓明,刘如钱,鲍传庆.腹腔镜下全直肠系膜切除术联合经肛管括约肌间切除术在超低位直肠癌保肛手术中的应用效果分析[J].实用临床医药杂志,2017,21(17):131-132.
[10]方复,卢国春,毛华辉.腹腔镜全系膜切除术联合经肛门内括约肌切除术治疗超低位直肠癌的疗效分析[J].中华全科医学,2017,15(4):724-726.
[11]王振军.内括约肌切除术治疗超低位直肠癌的进展和新问题[J].临床外科杂志,2017,25(4):251-254.
[12]韩寅,何勇,黄进.腹腔镜全直肠系膜切除术治疗老年中低位直肠癌的近期疗效及安全性评价[J].海南医学,2017,28(5):749-751.
[13]董博,黄博,董永红,等.腹腔镜与开腹全直肠系膜切除术治疗直肠癌的临床比较[J].肿瘤研究与临床,2016,28(10):679-682.