腹腔镜全直肠系膜切除术与腹腔镜辅助经肛门全直肠系膜切除术治疗中低位直肠癌临床疗效及安全性对比分析  

Comparison of Clinical Efficacy and Safety of Laparoscopic Total Mesorectal Excision and Laparoscope-assisted Transanal Total Mesorectal Excision in the Treatment of Middle and Low Rectal Cancer

作　　者：刘晶晶[1] 段乐乐[1] 余开湖[1] Liu Jingjing;Duan Lele;Yu Kaihu(Hubei Province Xianning Central Hospital.The First Affiliated Hospital of Hubei College of Science and Technology,Xianning,Hubei 437100,China)

机构地区：[1]咸宁市中心医院,湖北科技学院附属第一医院肛肠外科,放射科,湖北咸宁437100

出　　处：《四川医学》2018年第5期563-566,共4页Sichuan Medical Journal

摘　　要：目的探讨腹腔镜全直肠系膜切除术与腹腔镜辅助经肛门全直肠系膜切除术治疗中低位直肠癌临床疗效及安全性。方法选取我院2015年1月至2015年12月收治的直肠癌患者64例,根据患者手术方式的不同,将患者分为腹腔镜全直肠系膜切除术组(TEM)及腹腔镜辅助经肛门全直肠系膜切除术组(La-Ta TME)。比较两组患者临床疗效及并发症发生情况。结果 TEM组手术时间明显低于La-Ta TME组(P<0.05),La-Ta TME组术中出血量明显低于TEM组,差异有统计学意义(P<0.05);两组患者手术切除标本的直肠系膜完整度比较差异无统计学意义(P>0.05);TEM组患者下床活动时间明显低于La-Ta TME组,住院时间显著高于La-Ta TME组,差异有统计学意义(P<0.05);手术后TEM组出现2例(5.88%)肠梗阻,1例(2.94%)吻合口瘘,La-Ta TME组出现1例(2.94%)肠梗阻及1例(2.94%)骶前感染,两组患者手术后并发症发生情况差异无统计学意义(P>0.05);两组患者随访时间5~16个月,平均随访时间13.2个月,均未出现局部复发、远处转移及死亡者。结论腹腔镜全直肠系膜切除术与腹腔镜辅助经肛门全直肠系膜切除术治疗中低位直肠癌近期临床疗效及安全性相当,临床可根据患者个人病情选择手术方案。Objective To investigate the clinical efficacy and safety of laparoscopic total mesorectal excision and laparoscope-assisted transanal total mesorectal excision in the treatment of middle and low rectal cancer. Methods 64 patients with rectal cancer in our hospital from January 2015 to December 2015 year were selected.According to different surgery,the patients were divided into laparoscopic total mesorectal excision group（TEM）and laparoscope-assisted transanal total mesorectal excision group（La-TaTME）.The clinical efficacy and complications were compared between the two groups. Results The operation time of TEM group was significantly lower than that of La-TaTME group（ P 〈0.05）,the amount of bleeding in the La-TaTME group was significantly lower than that in TEM group,the difference was statistically significant（ P 〈0.05）.The mesorectal integrity of surgical specimens had no statistical significance between the two groups（ P 〉0.05）.The out of bed activity time in TEM group was significantly lower than that of La-TaTME group,and the hospitalization time was significantly higher than that of La-TaTME group,and the difference was statistically significant（ P 〈0.05）.There were 2（5.88%）cases of intestinal obstruction and 1（2.94%）cases of anastomotic fistula in TEM group.There were 1（2.94%）cases of intestinal obstruction and 1（2.94%）cases of presacral infection in La-TaTME group.The complications rate was no significant difference between the two groups after surgery（ P 〉0.05）.The patients in two groups were followed up for 5～16 months and the average follow-up time was 13.2 months.There was no local recurrence,distant metastasis and death during follow-up time. Conclusion The clinical efficacy and safety Laparoscopic total mesorectal excision and laparoscope-assisted transanal total mesorectal excision in the treatment of middle and low rectal cancer are similar.The clinical operation should be selected according to the individual situation of patient.

关 键 词：腹腔镜全直肠系膜切除术 腹腔镜辅助经肛门全直肠系膜切除术 中低位直肠癌 临床疗效 安全性 

分 类 号：R735.37[医药卫生—肿瘤]