腹腔镜辅助经肛全直肠系膜切除术的疗效分析  

Curative effect analysis of laparoscopic-assisted transanal total mesorectal excision:with a report of 70 cases

作　　者：潘伟[1] 温世春[1] 杨杰[1] 杜宗敏[1] 周睿[1] 张宏[2] PAN Wei;WEN Shi-chun;YANG Jie(Department of Surgical Oncology,Bengang General Hospital of China Resources Liaojian Group,Benxi 117000,China)

机构地区：[1]华润辽健集团本钢总医院肿瘤外科,辽宁本溪117000 [2]中国医科大学附属盛京医院结直肠肿瘤外科

出　　处：《腹腔镜外科杂志》2020年第8期589-593,共5页Journal of Laparoscopic Surgery

摘　　要：目的:比较腹腔镜辅助经肛全直肠系膜切除术(taTME)与传统腹腔镜全直肠系膜切除术(LaTME)治疗低位直肠癌的短期预后。方法:回顾分析2017年1月至2019年12月施行的70例taTME患者的临床资料,根据性别、年龄、体重指数、肿瘤位置、病理分期,匹配同一时期施行的70例LaTME手术,对比两组术中、术后指标。结果:taTME组手术时间、手术标本远切缘距离大于LaTME组(P<0.05),手工吻合比例、术中行保护性造口率高于LaTME组(P<0.05),术后排气时间短于LaTME组(P<0.05),住院费用及术后肠梗阻、尿潴留发生率低于LaTME组(P<0.05)。两组术中出血量、中转开腹率、术后住院时间、手术标本质量、淋巴结检出率、淋巴结阳性率、环周切缘阳性率、肿瘤病理TNM分期、组织学分型及直肠穿孔、前列腺出血、神经血管束出血、CO2栓塞、吻合口漏、吻合口出血、造口出口梗阻等并发症发生率差异均无统计学意义(P>0.05)。结论:taTME治疗低位直肠癌在手术相关指标、标本质量、围手术期并发症发生率、术后恢复速度等短期疗效方面与传统腹腔镜手术相当,且在手术标本远切缘、术后排气时间、住院费用及术后肠梗阻及尿潴留发生率等方面具有优势,值得进一步研究与推广。Objective:To compare the short-term prognosis of laparoscopic-assisted transanal total mesorectal excision(taTME)and traditional laparoscopic total mesorectal excision(LaTME)in the treatment of low rectal cancer.Methods:The clinical data of 70 consecutive patients who underwent taTME to treat low-level(≤7 cm from anal margin)rectal cancer from Jan.2017 to Dec.2019 were retrospectively analyzed.According to gender,age,body mass index,tumor location,and pathological stage,70 patients who underwent LaTME for low rectal cancer in the same period were defined as the LaTME group,and the various surgical indicators,clinical indicators and postoperative complications of the two groups were compared.Results:The operation time and distance from tumor to distant margin of taTME group was more than that of LaTME group(P<0.05);The proportion of manual anastomosis and incidence of preventive ileostomy in taTME group was higher than that in LaTME group(P<0.05);The time of the first postoperative exhaust in taTME group was shorter than that of LaTME group(P<0.05);The hospitalization cost and the incidence of postoperatively intestinal obstruction and urinary retention in taTME group were lower than those in LaTME group(P<0.05);Intraoperative blood loss,incidence of conversion to laparotomy,postoperative hospital stay,quality of surgical specimen,detection rate and positive rate of lymph nodes,positive rate of circumferential margin,TNM stage of tumor pathology,histological typing,rectal perforation,prostate hemorrhage,neurovascular bundle hemorrhage,CO2 embolism,anastomotic leakage,anastomotic hemorrhage,and stoma outlet obstruction were not statistically significantly different between the two groups(P>0.05).Conclusions:Compared with traditional laparoscopic surgery,laparoscopic-assisted taTME is non-inferior in terms of short-term efficacy such as surgical-related indicators,specimen quality,perioperative complication incidence,and postoperative recovery in the treatment of low rectal cancer.In addition,it has unique advanta

关 键 词：直肠肿瘤 腹腔镜检查 经肛 全直肠系膜切除术 病例对照研究 

分 类 号：R735.37[医药卫生—肿瘤]