腹腔镜下全直肠系膜切除术与传统直肠癌根治术治疗低位直肠癌的疗效比较  

Comparison of Laparoscopic Total Mesorectal Excision with Conventional Rectal Cancer Radical Surgery for Low Rectal Cancer

作　　者：张涛[1] 李定云[1] 赖家骏[1] 曾德强[1] 翁伟明[1] 朱晓峰[1] 王亮[1] ZHANG Tao;LI Dingyun;LAI Jiajun(Yuebei People’s Hospital of Shaoguan City,Shaoguan 512026,China)

机构地区：[1]广东省韶关市粤北人民医院,广东韶关512026

出　　处：《中国医学创新》2018年第20期120-124,共5页Medical Innovation of China

摘　　要：目的:观察腹腔镜下全直肠系膜切除术(LTME)与传统直肠癌根治术治疗低位直肠癌的疗效。方法:回顾性分析2013年9月-2017年4月术前经本院病理确诊为原发性低位直肠癌患者198例的临床资料,按照不同手术方法将其分为试验组(LTME)122例和对照组(传统直肠癌根治术)76例。比较两组手术情况、术后情况、并发症、近期疗效、肛门功能情况,分析影响LTME患者术后局部复发的因素。结果:试验组手术时间、病灶与远切缘距离均长于对照组,术中出血量、淋巴结清除数、术后住院、切口愈合、肛门排气时间均少于对照组,比较差异均有统计学意义(P<0.05);试验组并发症发生率为13.11%,低于对照组的19.74%,但比较差异无统计学意义(P>0.05);两组均随访1年,试验组局部复发率均低于对照组(P<0.05),两组生存率、远处转移率、肛门功能Kirwan分级比较,差异均无统计学意义(P>0.05);LTME患者的局部复发主要与肿瘤直径、病灶距肛缘距离、病灶与远切缘距离、分化程度、病理类型、术后放化疗、远处转移等因素有关(P<0.05),且以上因素均为影响直肠癌患者LTME术后局部复发的独立危险因素(P<0.05)。结论:腹腔镜下全直肠系膜切除术在治疗低位直肠癌的操作过程中具有出血少、分离明确、视野清晰的优势,可作为临床治疗低位直肠癌的首选方案。Objective：To observe the effect of laparoscopic total mesorectal excision（LTME） and conventional rectal cancer radical surgery for low rectal cancer.Method：The clinical data of 198 patients with primary low rectal cancer diagnosed by pathology in our hospital from September 2013 to April 2017 were analyzed retrospectively.According to different surgical methods,they were divided into 122 cases of experimental group（LTME） and 76 cases of control group（traditional rectal cancer radical operation）.The operation condition,postoperative condition,complications,short-term curative effect and anal function of two groups were compared,and the factors influencing postoperative local recurrence of LTME patients were analyzed.Result：The operative time,distance between lesion and distant incisal margin in experimental group were longer than those of control group,the intraoperative blood loss,lymph node clearance,hospitalization time,incision healing time and anal exhaust time were less than those of control group,the differences were statistically significant（P〈0.05）.The incidence of complications in experimental group was 13.11%,lower than 19.74% in control group,but the difference was not statistically significant（P〈0.05）.They were followed up for 1 year,the local recurrence rate in experimental group was lower than that of control group（P〈0.05）,and the survival rate,distant metastasis rate and Kirwan classification of anal function between two groups were compared,the difference was not statistically significant（P〈0.05）.The local recurrence of LTME was mainly related to the diameter of the tumor,the distance from the lesion to the anal margin,the distance between the focus and the distal margin,the degree of differentiation, the pathological type,the postoperative radiotherapy and chemotherapy, and the distant metastasis（P〈0.05）,and all the above factors were independent risk factors for local recurrence after rectal cancer patients underwent LTME（P〈0.05）.Conclusion�

关 键 词：腹腔镜下全直肠系膜切除术 传统直肠癌根治术 低位直肠癌 

分 类 号：R735.37[医药卫生—肿瘤]