腹腔镜下超低位直肠癌术式选择及术后生活质量观察  

Laparoscopic surgical options for ultralow rectal cancer and observed postoperative quality of life

作　　者：朱信强[1] 张明[1] 丁闯[1] 孔令永[1] 陈焰[1] 管文贤[2] 

机构地区：[1]南京大学医学院附属鼓楼医院集团宿迁市人民医院普外科,223800 [2]南京大学医学院附属鼓楼医院普外科,210000

出　　处：《中华结直肠疾病电子杂志》2017年第1期46-51,共6页Chinese Journal of Colorectal Diseases(Electronic Edition)

摘　　要：目的探讨腹腔镜下超低位直肠癌的手术方式以及术后生活质量情况。方法对2013至2015年间南京鼓楼医院集团宿迁市人民医院普外科收治的超低位直肠癌患者24例,分别采用腹腔镜下腹会阴联合切除术(APR),腹腔镜辅助肛门原位再造术和腹腔镜联合骶尾入路手术3种方式,术后生活质量评价采取Wexner评分和大便生活质量调查问卷。数据之间比较采取非参数检验,其中多组独立样本比较常规采用K-WH检验。结果所有患者成功实施手术,术后病理切缘、环周切缘及淋巴结计数符合直肠癌肿瘤安全性指标。Wexner评分,手术术后3月、6月、9月差异有统计学意义(H值分别为6.388,8.246,6.563;P值分别为0.043,0.021,0.044)。大便生活质量调查问卷,术后9个月,3组之间对比差异有统计学意义(H值分别为4.568,6.342,5.479,7.236;P值分别为0.024,0.015,0.047,0.031)。而经骶尾术式组,问卷的各项指标接近正常。结论腹腔镜下超低位直肠癌经骶保肛手术是可行的,术后生活质量较其他治疗组明显改善。Objective To discuss the laparoscopic surgery procedure of ultra-low rectal cancer and postoperative quality of life. Methods 24 cases of super low rectal cancer treated by general surgery in Suqian People？s Hospital of Nanjing Drum Tower Hospital from 2013 to 2015 were treated with laparoscopic assisted abdominoperineal nealresection（APR）, laparoscopic assisted anal in situ re-laparoscopy combined with sacrococcygeal approach, postoperative quality of life evaluation Wexner score and stool quality of life questionnaire. Data were compared between non-parametric test, in which multiple groups of independent samples are more commonly used K-WH test. Results All patients underwent successful operation, and the margins of resection margin, circumcision margin and lymph node count accorded with tumor safety index of rectal cancer. Wexner score showed significant difference between the 3th month, 6th month and 9th month after operation（H=6.388, 8.246, 6.563, P=0.043, 0.021, 0.044）. The fecal incontinence quality of life questionnaire in the 9th month after operation, the difference in the three groups was statistically significant（H= 4.568, 6.342, 5.479, 7.236, P=0.024, 0.015, 0.047, 0.031）. The sacrococcygeal surgery group, the indicators of the questionnaire close to normal. Conclusion Laparoscopic ultra-low rectal cancer surgery is feasible by the sacral anus, postoperative quality of life was improved significantly than other treatment groups.

关 键 词：腹腔镜 直肠肿瘤 术式 生活质量 

分 类 号：R735.37[医药卫生—肿瘤]