腹腔镜下经肛门括约肌间切除超低位直肠癌158例分析  

Comparative study of three laparoscopic transanal sphincter resection in the treatment of 158 patients with ultra⁃low rectal cancer

作　　者：罗亮[1] 张永川[1] 沈攀 LUO Liang;ZHANG Yongchuan;SHEN Pan(Department of General Surgery,Central Hospital of Dazhou City,Dazhou,Sichuan 635000,China)

机构地区：[1]达州市中心医院普外科,四川达州635000

出　　处：《安徽医药》2020年第12期2470-2473,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨腹腔镜下部分切除、次全切除及完全切除经肛门括约肌间切除术(Intersphincter resection,ISR)术式对Ⅰ~Ⅲ期超低位直肠癌病人肛门功能、安全性及生存结局的影响。方法回顾性分析达州市中心医院2013年1月至2016年1月收治Ⅰ~Ⅲ期超低位直肠癌病人共158例临床资料,根据手术方案不同分为A组(54例)、B组(70例)及C组(34例),分别采用腹腔镜下部分切除、次全切除及完全切除ISR术式治疗;比较三组围手术期临床指标,术后肛门功能相关指标、吻合口相关并发症发生率及随访结局指标。结果三组手术时间、术中出血量、淋巴结清扫数目及术后住院时间比较差异无统计学意义(P>0.05);三组术后排便急迫率、止泻药物依赖率、失禁率、Wexner失禁评分及Kinwan失禁分级比较差异无统计学意义(P>0.05);三组术后吻合口周围黏膜缺血、吻合口瘘、直肠阴道瘘及直肠坏死发生率比较差异无统计学意义(P>0.05);A组、B组及C组术后吻合口慢性狭窄发生率分别为9.26%,10.00%,29.41%(P<0.05);三组术后复发率、3年无病生存率及无局部复发生存率比较差异无统计学意义(P>0.05)。结论腹腔镜下部分切除、次全切除及完全切除ISR术式治疗Ⅰ~Ⅲ期超低位直肠癌在术后肛门功能保护和生存结局方面均较为接近;但完全切除ISR术式应用可能增加术后吻合口慢性狭窄发生风险。Objective To investigate the influence of partial resection,subtotal resection and total resection intersphincteric resec⁃tion(ISR)operation by laparoscopy on anal function,safety and survival outcomes of patients with utra⁃low rectal cancer for stageⅠtoⅢ.Methods One hundred and fifty⁃eight patients with utra⁃low rectal cancer for stageⅠtoⅢin Dazhou Central Hospital from January 2013 to January 2016 were chosen and assigned into 3 groups according to operation scheme,including A group(54 patients)with partial resection ISR,B group(70 patients)with subtotal resection ISR and C group(34 patients)with total resec⁃tion ISR operation by laparoscopy.The perioperative clinical indicators,postoperative anal function related indicators,incidence of anastomotic complications and outcome indicators with follow⁃up of 3 groups were compared.Results There was no significant dif⁃ference in the operation time,intraoperative blood loss,lymph node dissection number and postoperative hospital staying time among 3 groups(P>0.05).There was no significant difference in the postoperative defecation urgent rate,antidiarrheal drug depen⁃dence rate,incontinence rate,Wexner incontinence score and Kinwan incontinence classification among 3 groups(P>0.05).There was no significant difference in incidence of postoperative anastomotic mucosal ischemia,anastomotic leakage,rectovaginal fistula and rectal necrosis among 3 groups(P>0.05).The incidence of postoperative chronic anastomotic stenosis in A group,B group and C group were 9.26%,10.00%and 29.41%,respectively(P<0.05).There was no significant difference in postoperative recurrence rate,disease⁃free survival rate and relapse free survival rate in 3 year with follow⁃up among 3 groups(P>0.05).Conclusion Par⁃tial resection,subtotal resection and total resection ISR operation by laparoscopy in the treatment of patients with utra⁃low rectal cancer for stageⅠtoⅢpossess the same postoperative anal function preservation and survival outcome;but total resection ISR

关 键 词：直肠肿瘤 腹腔镜检查 结直肠外科手术 肛管 

分 类 号：R735.37[医药卫生—肿瘤]