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  

Comparison Between Laparoscopic Transanal Pull Through Surgery and Laparoscopic Anterior Resection of Rectum for Low Rectal Cancer

作　　者：张永康[1] 张剑[1] 廖晓锋[1] 

机构地区：[1]湖北文理学院附属医院襄阳市中心医院普外3科,襄阳441021

出　　处：《中国微创外科杂志》2016年第8期736-739,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：湖北省自然科学基金资助项目(2012FFC05001)

摘　　要：目的探讨腹腔镜下直肠经肛门拖出式手术治疗低位直肠癌的疗效与可行性。方法回顾性分析2009年12月-2014年9月低位直肠癌的临床资料,腹腔镜下直肠经肛门拖出式手术20例（拖出组）,腹腔镜下直肠低位前切除术21例（对照组）,2组一般资料差异无显著性,比较2组手术时间、出血量、术后并发症、术后肛门功能、术后病理切缘距离及短期局部复发情况。结果 2组手术时间及术中出血量、淋巴结清扫数差异无显著性（P〉0.05）。术后病理显示拖出组手术切缘距离肿瘤更远[（3.9±1.2）cm vs.（2.9±1.2）cm,t=2.667,P=0.011]。对照组术后吻合口漏1例。术后1个月及半年后控便情况差异无显著性（P〉0.05）。拖出组术后随访（28.4±16.8）月,无局部复发及转移;对照组术后随访（28.8±16.4）月,术后复发2例（P=0.488）。结论腹腔镜下直肠经肛门外翻拖出式手术治疗低位直肠癌手术更加简便易行,手术效果满意,安全可靠。Objective To investigate the efficacy and feasibility of laparoscopic transanal pull-through（ LTPT） surgery with anal sphincter preservation in the treatment of low rectal cancer. Methods Clinical data of 41 cases of low rectal cancer from December 2009 to September 2014 were studied retrospectively. The LTPT was preformed in 20 cases,and laparoscopic anterior resection（ LAR） in 21 cases. The operation time,bleeding volume,postoperative complications,postoperative anal functions,postoperative pathological margin distance,and short-term local recurrence rate between the two groups were compared. Results The operative time,operative blood loss,and number of lymph node resected had no differences between the two groups（ P〉0. 05）.Postoperative pathological examinations showed the cutting edge in the LTPT group was further than that in the LAR group [（ 3. 9 ±1. 2） cm vs.（ 2. 9 ± 1. 2） cm,t = 2. 667,P = 0. 011]. One case of anastomotic leakage happened in the LAR group. There was no significant difference in postoperative anal functions after one month and six months between the two groups（ P〈0. 05）. The LTPT group was followed up for（ 28. 4 ± 16. 8） months,and the LAR group for（ 28. 8 ± 16. 4） months. No local recurrence or metastasis was observed in the LTPT group,while 2 cases of recurrence occurred in the LAR group（ P = 0. 488）. Conclusions LTPT with anal sphincter preservation,which is simpler and easier than LAR,is safe and reliable. Its treatment effects are satisfying.

关 键 词：腹腔镜 低位直肠癌 经肛门 

分 类 号：R735.37[医药卫生—肿瘤]