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目的直肠癌是消化道最常见的恶性肿瘤之一,其中超低位及低位直肠癌占较大比例,其治疗方式主要是手术切除,腹腔镜全直肠系膜切除术(total mesorectum excision,TME)联合括约肌间切除术(intersphincteric resection,ISR)治疗超低位直肠癌切除术得到了广泛应用,然而,该术式的安全性和可行性仍需探讨。方法收集桐庐县第一人民医院2008年1月—2015年1月的超低位直肠癌患者96例,根据不同术式分为腹腔镜组和开腹组,腹腔镜组46例患者,行腹腔镜联合经肛门括约肌间超低位直肠癌切除术,开腹组50例患者,行开腹联合经肛门括约肌间超低位直肠癌切除术。对比分析2组患者的手术时间、出血量、清扫淋巴结数、住院时间、肛门排气时间及术后并发症发生率,以及肛门功能满意度、KIRWAN分级、排便频率、排便紧迫感发生率和排便困难发生率。结果与开腹组相比,腹腔镜组患者手术时间(152.4±38.2)min、出血量(45.2±21.8)ml、住院时间(9.7±1.2)d、肛门排气时间(2.1±0.8)d及术后并发症发生率(4.3%)均明显更小,腹腔镜组清扫淋巴结数(12.3±0.7)明显多于开腹组(11.9±0.8),差异有统计学意义(P<0.05);2组患者在肛门功能满意度、KIRWAN分级、排便频率、排便紧迫感发生率及排便困难发生率方面,组间差异均无统计学意义(P>0.05)。结论腹腔镜下TME联合ISR治疗超低位直肠癌具有创伤小、术后恢复快、安全性高等优势,且与开腹术后肛门功能和生活质量差异无统计学意义,值得临床进一步推广应用。
Objective Rectal cancer is one of the most common malignant tumors of the digestive tract. Ultra-low and low rectal cancers account for a large proportion. The treatment is mainly surgical resection, total mesorectum excision (TME) combined with sphincter Interstitial resection (ISR) has been widely used in the treatment of ultra-low rectal cancer. However, the safety and feasibility of this procedure are still to be explored. Methods Ninety-six patients with ultra-low rectal cancer were collected from January 2008 to January 2015 in Tonglu County First People’s Hospital. According to different surgical procedures, they were divided into laparoscopic group and open group, and laparoscopic group of 46 patients undergoing laparoscopic Combined transanal sphincter ultra-low rectal cancer resection, open group of 50 patients underwent open abdominal trans-anal sphincter ultra-low rectal cancer resection. The operative time, amount of bleeding, number of lymph nodes dissected, length of hospital stay, anal exhaust time and incidence of postoperative complications were compared between the two groups as well as satisfaction of anal function, KIRWAN classification, frequency of bowel movements, incidence of defecation urgency and defecation Difficulty. Results Compared with the open group, the operative time (152.4 ± 38.2) min, bleeding volume (45.2 ± 21.8) ml, hospital stay (9.7 ± 1.2) d, anal exhaust time (2.1 ± 0.8) d and The incidence of postoperative complications was significantly lower (4.3%). The number of lymph nodes in laparoscopic group (12.3 ± 0.7) was significantly higher than that in open group (11.9 ± 0.8) (P <0.05). 2 There was no significant difference between the two groups in anal function satisfaction, KIRWAN grade, defecation frequency, incidence of urgency of bowel movement and defecation rate (P> 0.05). Conclusions Laparoscopic TME combined with ISR in the treatment of ultralow rectal cancer has the advantages of less trauma, faster recovery and higher safety. There is no significant difference between anal function and quality of life after laparotomy, which is worth further clinical application.