腹腔镜全直肠系膜切除术+经肛门括约肌间切除术治疗超低位直肠癌效果及术后并发症观察  

Effects of Laparoscopic TME Combined with Transanal ISR in Treatment of Ultra-low Rectal Cancer and Observation of Postoperative Complications

作　　者：王励[1] 刘建[1] 张勇[1] 祝东强[1] WANG Li;LIU Jian;ZHANG Yong;ZHU Dong-qiang(Department of General Surgery,the Fifth People＇s Hospital of Chengdu,Chengdu 611230,China)

机构地区：[1]成都市第五人民医院普通外科,成都611130

出　　处：《解放军医药杂志》2018年第8期5-8,28,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：四川省医学科研青年创新课题计划课题(Q15083)

摘　　要：目的探讨腹腔镜全直肠系膜切除术(TME)+经肛门括约肌间切除术(ISR)与开腹ISR治疗超低位直肠癌围术期指标、胃肠功能恢复指标、肛门功能满意度及术后并发症的影响。方法选取2014年1月—2017年1月成都市第五人民医院收治的超低位直肠癌110例,依据手术方式不同分为观察组和对照组,每组55例,观察组行腹腔镜TME+ISR,对照组行开腹ISR,记录2组围术期指标、手术前后胃肠功能恢复指标(胃动素、胃泌素、Wexner便秘评分)及术后6个月肛门功能分级、肛门功能满意度、并发症及生存率。结果观察组手术时间、住院时间、肛门排气时间、肠鸣音恢复时间均短于对照组,术中出血量少于对照组(P<0.05),2组淋巴结清扫数目比较差异无统计学意义(P>0.05);术后1个月观察组血清胃动素、胃泌素水平高于对照组,Wexner便秘评分低于照组(P<0.01);术后6个月观察组肛门功能分级、肛门功能满意度与对照组比较差异无统计学意义(P>0.05),观察组并发症发生率低于对照组(P<0.05);术后6个月、1年2组生存率比较差异无统计学意义(P>0.05)。结论腹腔镜TME+ISR治疗超低位直肠癌,患者肛门功能及其满意度、生存率与开腹ISR相当,且创伤小、胃肠功能恢复快,值得临床推广应用。Objective To investigate effects of laparoseopie total mesoreetal excision （TME） combined with transanal intersphineterie resection （iSR） and open iSR on perioperative indexes of rectal cancer, recovery indexes of gastrointestinal function, satisfaction degree of anal function and postoperative complications in patients with uhra-low rectal cancer. Methods A total of 110 patients with uhra-low rectal cancer admitted during January 2014 and January 2017 were divided into observation group and control group （n=55 for each group） according to different treatment methods. Observation group was treated with laparoseopie TME ＋ ISR, while control group was treated with open ISR. Periopera- tire indexes, recovery indexes of gastrointestinal function before and after operation [ motilin （MTL） , gastrin （GAS） , Wexner constipation score] and anal function grades, satisfaction degree of anal function, incidence rate of complications and survival rate in postoperative 6 months were recorded in two groups. Results in observation group, values of opera- tive time, hospital stay, passage time of gas by anus, recovery time of bowel sounds and intraoperative bleeding volume were significantly lower than those in control group （P （0. 05） , but there was no significant difference in number of lymph node dissection between two groups （P 〉 0.05）. In 1 month after operation, in observation group, serum MTL and GAS levels were significantly higher, while Wexner constipation score was significantly lower than those in control group （P 〈0. 01）. In postoperative 6 months, there were no significant differences in anal functional grades and satisfaction degree of anal function between two groups （P 〉 O. 05） , and incidence rate of complications in observation group was sig- nificantly lower than that in control group （P 〈 0. 05）. There were no significant differences in survival rate between the two groups in 6 months and 1 year after operation （P 〉 0.05）. Conclusion Laparoscopic TME

关 键 词：超低位直肠癌 腹腔镜全直肠系膜切除术 经肛门括约肌间切除术 并发症 

分 类 号：R735.37[医药卫生—肿瘤]