腹腔镜辅助经肛全直肠系膜切除术与腹腔镜全直肠系膜切除术治疗低位直肠癌的疗效比较  

Laparoscopic-assisted transanal total mesorectal excision versus laparoscopic total mesorectal excision for low rectal cancer

作　　者：刘晓辉 朱晓峰 王伟[2] 熊文俊 郑燕生 罗立杰 LIU Xiaohui;ZHU Xiaofeng;WANG Wei;XIONG Wenjun;ZHENG Yansheng;LUO Lijie(Department of General Surgery,Baoan Central Hospital(the Fifth Affiliated Hospital of Shenzhen University),Shenzhen,Guangdong 518102,China;Department of Gastrointestinal Surgery,Guangdong Provincial Hospital of Traditional Chinese Medicine(the Second Affiliated Hospital of Guangzhou University of Chinese Medicine),Guangzhou 510120,China)

机构地区：[1]广东省深圳市宝安区中心医院(深圳大学第五附属医院)普通外科,广东深圳518102 [2]广东省中医院(广州中医药大学第二附属医院)胃肠外科,广东广州510120

出　　处：《中国普通外科杂志》2020年第10期1165-1171,共7页China Journal of General Surgery

摘　　要：背景与目的:全直肠系膜切除术(TME)是治疗直肠癌的标准术式,与开放TME比较,腹腔镜辅助TME(LaTME)不仅降低了手术创伤,且疗效相当。但对于肥胖、骨盆狭窄、男性低位直肠癌患者,LaTME的盆腔操作仍十分困难,且环周切缘(CRM)阳性的风险增加。腹腔镜辅助经肛TME(TaTME)的出现为低位直肠癌切除术提供了一种创新的微创选择,给外科医生提供新的解决方案。本研究比较分析腹腔镜辅助TaTME与LaTME治疗低位直肠癌的临床疗效。方法:回顾性分析广东省中医院胃肠外科2018年7月—2019年1月收治的30例低位直肠癌患者(肿瘤下缘距肛门距离≤5 cm)的临床资料。其中12例行腹腔镜辅助TaTME(TaTME组),18例行LaTME(LaTME组)。比较两组患者的相关临床指标。结果:两组患者在年龄、性别、BMI、ASA分级、肿瘤学分期、肿瘤下缘距肛门距离、肿瘤直径等一般资料均无明显差异(均P>0.05)。两组患者无中转开腹手术,无近期死亡病例。TaTME组较LaTME组手术时间明显缩短(168.5 min vs.239.33 min,P=0.007)、出血量明显减少(66.50 mL vs.160.00 mL,P=0.002)。两组在预防性造口、保肛率、CRM阳性率、淋巴结清扫总数方面差异无统计学意义(均P>0.05)。TaTME组术后住院时间明显短于LaTME组(6.33 d vs.10.83 d,P<0.001)、住院费用明显低于LaTME组(58963元vs.81341元,P<0.001),TaTME组的术后排气时间及恢复全流饮食时间均短于LaTME组,但差异无统计学意义(均P>0.05)。两组术后并发症发生率差异无统计学意义(P>0.05)。结论:腹腔镜辅助TaTME治疗低位直肠癌与LaTME的短期疗效相当,且在某些方面具有一定优势;是安全可行的,值得临床进一步研究和应用。Background and Aims:Total mesorectal excision(TME)is a standard technique for treatment of rectal cancer.Compared with open TME,laparoscopic-assisted TME(LaTME)has not only the advantage of minimal invasiveness,but also similar oncological outcomes.However,in obese,narrow-pelvis or male low rectal cancer patients,the pelvic operation of LaTME is still difficult,with increased risk of positive circumferential resection margin(CRM).The advent of laparoscopic-assisted transanal TME(TaTME)provides an innovative and minimally invasive option for low rectal cancer resection and provides new solutions for surgeons.This study was conducted to compare and analyze the clinical efficacy of laparoscopic-assisted TaTME and LaTME in treatment of low rectal cancer.Methods:The clinical data of 30 patients with low rectal cancer(the distance between inferior margin of tumor and anal verge≤5 cm)treated in the Department of Gastrointestinal Surgery,Guangdong Provincial Hospital of Traditional Chinese Medicine from July 2018 to January 2019 were retrospectively analyzed.Of the patients,12 cases underwent laparoscopic assisted TaTME(TaTME group),and 18 cases underwent LaTME(LaTME group).The main clinical variables were compared between the two groups of patients.Results:There were no significant differences between the two groups of patients in terms of general data such as age,sex,BMI,ASA grade,oncological stage,distance from the inferior margin of the tumor to the anus,and tumor diameter(all P>0.05).No open conversion required and no early death occurred in both groups.The operative time of TaTME group was significantly shorter and the intraoperative blood loss was significantly less than those of LaTME group(168.5 min vs.239.33 min,P=0.007;66.50 mL vs.160.00 mL,P=0.002),and no significant differences were noted with regard to preventive ileostomy,anus preservation rate,CRM-positive rate and total lymph node dissection(all P>0.05).The length of hospital stay of TaTME group was significantly shortened and the hospitalization cost

关 键 词：直肠肿瘤 全直肠系膜切除术 腹腔镜 最小侵入性外科手术 

分 类 号：R735.3[医药卫生—肿瘤]