腹腔镜联合肛门内镜行低位直肠癌根治术的疗效分析  

Clinical effect of laparoscopy combined with transanal endoscopic radical resection for low rectal cancer

作　　者：谢文健 杨洪 华烨[2] XIE Wen-jian;YANG Hong;HUA Ye(Department of General Surgery,Digestive Disease Center,Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Department of General Surgery,Chongqing Emergency Medical Center,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第三医院消化疾病中心普外科,重庆401120 [2]重庆市急救医疗中心普通外科,重庆400010

出　　处：《局解手术学杂志》2020年第9期747-751,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：重庆市卫生计生委医学科研项目(2015MSXM0780)。

摘　　要：目的探讨腹腔镜联合肛门内镜治疗低位直肠癌患者的临床疗效。方法回顾性分析重庆市急救医疗中心结直肠外科2013年4月至2017年10月收治的64例低位直肠癌患者的临床资料,按照手术方法的不同分为对照组和观察组,每组32例。对照组患者行腹腔镜全直肠系膜切除术治疗,观察组患者行肛门内镜联合腹腔镜全直肠系膜切除术治疗。比较2组患者的手术时间、腹壁切口长度、术中出血量、术后首次排气时间、首次下床活动时间、住院时间等相关指标,比较2组患者肺部感染、造口出血、切口漏等并发症发生情况及术后2年复发转移率,同时比较术前及术后1个月2组患者胃泌素、胃动素等胃肠指标水平,比较术后6个月及12个月2组患者的肛门功能Wexner评分。结果观察组与对照组患者的手术时间、术后首次排气时间、首次下床活动时间、住院时间比较差异无统计学意义(P>0.05),观察组患者腹壁切口长度及术中出血量均短/少于对照组(P<0.05)。观察组患者并发症总发生率低于对照组(P<0.05)。术后1个月观察组患者血清胃泌素、胃动素水平高于对照组(P<0.05)。术后6个月观察组患者Wexner评分低于对照组(P<0.05),但术后12个月2组患者Wexner评分比较差异无统计学意义(P>0.05)。术后2年2组患者复发转移率比较差异无统计学意义(P>0.05)。结论腹腔镜联合肛门内镜治疗低位直肠癌的疗效及术后2年内复发转移情况与腹腔镜全直肠系膜切除术相当,但其术后并发症发生率更低,对患者胃肠功能及肛门功能影响更小。Objective To explore the clinical effect of laparoscopy combined with transanal endoscopic radical resection in the treatment of patients with low rectal cancer.Methods A retrospective analysis was performed on the clinical data of 64 patients with low rectal cancer admitted to colorectal surgery department of Chongqing Emergency Medical Center from April 2013 to October 2017,those patients were divided into the control group and the observation group according to the different operation methods,with 32 cases in each group.Patients in the control group were treated by laparoscopic total mesorectal excision,and patients in the observation group were treated by laparoscopy combined with transanal endoscopic radical resection.The operative related indexes such as the operation time,length of abdominal incision,intraoperative bleeding volume,first postoperative exhaust time,time of getting out of bed,hospital stay between two groups were compared.The incidence of complications occurrence such as pulmonary infection,stoma bleeding,incision leakage and the recurrence and metastasis rate 2 years after operation were compared between two groups.The level of gastrointestinal index like gastrin and motilin before and 1 month after operation,anal anal function Wexner scores in 6 months and 12 months after operation were compared between two groups.Results There was no significant difference between the two groups in operation time,first postoperative exhaust time,time of getting out of bed,hospital stay(P>0.05).The length of abdominal incision and intraoperative bleeding volume in the observation group were shorter/less than those in the control group(P<0.05).The total incidence of complications in the observation group was lower than that in the control group(P<0.05).Serum gastrin and motilin in the observation group 1 month after operation were higher than those in the control group(P<0.05).The anal function Wexner scores 6 months after operation in the observation group was lower than that in the control group(P<0.05),bu

关 键 词：双镜联合技术 低位直肠癌 胃肠指标 肛门功能 全直肠系膜切除术 胃泌素 胃动素 

分 类 号：R735.37[医药卫生—肿瘤]