腹腔镜下改良Parks术治疗超低位直肠癌的临床疗效  

Clinical efficacy of laparoscopic modified Parks operation on the ultra-low rectal cancer

作　　者：丁海波 李坚[1] 杨智 彭吒 廖新 DING Haibo;LI Jian;YANG Zhi;PENG Zha;LIAO Xin(Department of Colorectal and Anal Surgery,Xiangya Hospital,Central South University,Changsha 410008;Department of General Surgery,Xiangtan First People’s Hospital,Xiangtan Hunan 411101,China)

机构地区：[1]中南大学湘雅医院结直肠肛门外科,长沙410008 [2]湘潭市第一人民医院普通外科,湖南湘潭411101

出　　处：《中南大学学报（医学版）》2021年第2期121-126,共6页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(2016JJ2106,2019JJ40510)。

摘　　要：目的:探讨腹腔镜下改良Parks术在超低位直肠癌中的临床疗效。方法:依据患者术前分期及术中吻合口位置,对98例T2期以上超低位直肠癌患者分别行腹腔镜下超低位Dixon术、改良Parks术和Miles术,并将患者分为Dixon组(39例)、改良Parks组(43例)、Miles组(16例)。收集所有患者的临床资料及术后随访结果,并对其进行对比分析,评估腹腔镜下改良Parks术的临床疗效。结果:与Dixon组相比,改良Parks组患者更加肥胖、肿瘤距肛缘距离更近、手术时间更长(均P<0.05);两组患者在手术出血量、淋巴结检出数、术后并发症方面差异均无统计学意义(均P>0.05);而且改良Parks组患者的术后排气排便时间和住院时间更短、住院总费用也更低(均P<0.05)。虽然改良Parks组患者术后早期的肛门功能较差,但随着规律的肛门功能锻炼,从术后6个月开始达到与Dixon组相近的水平(P>0.05)。与Miles组相比,改良Parks组患者在肿块大小、体型、肿瘤距肛缘距离、手术时间、手术出血量、淋巴结检出数目、术后排气排便时间方面差异均无统计学意义(均P>0.05),但改良Parks组住院时间更短、并发症发生率更低、住院总费用也更低(均P<0.05)。结论:腹腔镜下改良Parks术是一种安全、经济、有效的保肛术式,不但可以为一部分原本只能行Miles术的患者保住肛门,而且术后患者恢复得更好、更快,虽然早期肛门功能较差,但可逐渐恢复至与Dixon术相当的水平。Objective:To investigate the clinical efficacy of laparoscopic modified Parks operation on the patients with ultra-low rectal cancer.Methods:According to the preoperative stage and intraoperative anastomotic position,98 patients with ultra-low rectal cancer above T2 stage underwent laparoscopic Dixon operation,modified Parks operation and Miles operation,respectively.All patients were divided into 3 groups:a Dixon operation group(n=39),a modified Parks operation group(n=43)and a Miles operation group(n=16).The clinical data and postoperative follow-up results were collected,compared,and analyzed to evaluate the clinical efficacy of laparoscopic modified Parks operation.Results:The patients were more obese,the distance between tumor and anal margin was closer,and the operation time was longer in the modified Parks operation group than those in the Dixon operation group(all P<0.05).However,the results of bleeding volume,the number of lymph nodes and the postoperative complications in the modified park operation group were similar than those in the Dixon operation group(all P>0.05).In addition,the exhaust and defecation time and the hospitalization time were shorter,and the total cost of hospitalization was lower in the modified Parks operation group than those in the Dixon operation group(all P<0.05).Although the anal function in the modified Parks operation group was poor in the early postoperative period,it reached the same level as that in the Dixon operation group from 6 months after the treatments with the regular anal function exercise(P>0.05).There were no significant differences in tumor size,body shape,distance between tumor and anal margin,operation time,bleeding volume,number of lymph nodes detected,postoperative exhaust and defecation time between the Miles operation group and the modified Parks operation group,but the hospitalization time was shorter,the incidence of complications and the total cost of hospitalization were lower in the modified Parks operation group(all P<0.05).Conclusion:Laparoscopic

关 键 词：改良经肛门结肠肛管吻合术 超低位 直肠癌 保肛手术 

分 类 号：R735.37[医药卫生—肿瘤]