经结肠系膜入路在经肛全直肠系膜切除术中的应用价值  

Application value of mesocolon approach in transanal total mesorectal excision

作　　者：滕庆 蒲敏[1] 杨选华[1] 任明扬[1] 周冬兵[1] 吕真冰 李权林[1] 覃相志 张大权 Teng Qlng;Pu Min;Yang Xuanhua;Ren Minngyang;Zhou DongbingLyu Zhenbing;Li Quunlin;Qin Xiangzhi;Zhang Daquan(Department of Gastrointestinal Surgery,Nanchong Central Hospital,North Sichuan Medical College,Nanchong 637000,Sichuan Province,China)

机构地区：[1]川北医学院附属南充市中心医院胃肠外科,四川南充637000

出　　处：《中华消化外科杂志》2020年第3期296-301,共6页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81401927);四川省医学科研课题计划(S15049)。

摘　　要：目的探讨经结肠系膜入路在经肛全直肠系膜切除术(TaTME)中的应用价值。方法采用回顾性队列研究方法。收集2018年1-12月川北医学院附属南充市中心医院收治的61例中低位直肠癌患者的临床病理资料;男41例,女20例;平均年龄为62岁,年龄范围为43~81岁。61例患者中,30例行TaTME采用常规腹腔镜直肠癌手术入路设为传统入路组;31例行TaTME采用经结肠系膜入路设为结肠系膜入路组。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用门诊和电话方式进行随访,术后每3个月随访1次,了解患者术后肿瘤局部复发和转移情况。随访时间截至2019年6月。正态分布的计量资料以±s表示,组间比较采用t检验。偏态分布的计量资料以M(范围)表示,组间比较采用Mann-Whitney U检验。计数资料以绝对数或百分比表示,组间比较采用χ^2检验或Fisher确切概率法。等级资料组间比较采用Mann-Whitney U检验。结果(1)手术情况:两组患者均顺利完成TaTME,无中转开腹。传统入路组患者经腹游离时间,术中出血量,肿瘤标本远切缘长度,肿瘤标本近切缘长度,系膜完整度(系膜完整、系膜近完整)例数,环周切缘阳性率,远切缘阳性率,淋巴结检出数目分别为(126±56)min,41.0 mL(17.5~71.4 mL),1.3 cm(0.8~2.0 cm),(10.0±5.0)cm,10、20例,3.3%(1/30),0,13.7枚(9.0~17.0枚)。结肠系膜入路组患者上述指标分别为(101±30)min,44.0 mL(25.0~67.5 mL),1.6 cm(1.1~2.2 cm),(12.0±3.0)cm,23、8例,6.5%(2/31),0,13.0枚(10.9~17.3枚)。两组患者经腹游离时间、肿瘤标本近切缘长度、系膜完整度比较,差异均有统计学意义(t=2.133,-2.286,χ^2=10.250,P<0.05);两组患者术中出血量、肿瘤标本远切缘长度、淋巴结检出数目比较,差异均无统计学意义(Z=-0.662,-1.107,0.304,P>0.05)。两组患者环周切缘阳性率、远切缘阳性率比较,差异均无统计学意义(P>0.05)。(2)术后情况:传统入路组患者术后首次肛�Objective To investigate the application value of mesocolon approach in transanal total mesorectal excision(TaTME).Methods The retrospective cohort study was conducted.The clinicopathological data of 61 patients with middle or low rectal cancer who were admitted to the Nanchong Central Hospital of North Sichuan Medical College from January to December in 2018 were collected.There were 41 males and 20 females,aged from 43 to 81 years,with an average age of 62 years.Of the 61 patients,30 patients undergoing TaTME with the conventional approach were allocated into traditional approach group,and 31 patients undergoing TaTME with mesocolon approach were allocated into mesocolon approach group.Observation indicators:(1)surgical situations;(2)postoperative recovery;(3)follow-up.Follow-up was conducted by outpatient examination and telephone interview once every 3 months to detect local recurrence and metastasis of tumors in patients up to June 2019.Measurement data with normal distribution were expressed as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were expressed as M(range),and comparison between groups was conducted using the Mann-Whitney U test.Count data were expressed as absolute numbers or percentages,and comparison between groups were analyzed using the chi-square test or Fisher exact probability.Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test.Results (1)Surgical situations:patients in the two groups underwent TaTME successfully,without conversion to laparotomy.The transabdominal operation time,volume of intraoperative blood loss,length of distal margin from surgical specimen,length of proximal margin from surgical specimen,cases with complete mesentery or with nearly complete mesentery(the integrity of mesentery),positive rate of circumferential margin,positive rate of distal margin,and the number of lymph node dissected of the traditional approach group were(126±56)minutes,41.0 mL(range,17.5-71.4 mL),1.3

关 键 词：直肠肿瘤 结肠系膜入路 系膜裁剪 经肛门全直肠系膜切除术 微创手术 腹腔镜检查 

分 类 号：R735[医药卫生—肿瘤]