腹腔镜下经肛门括约肌间切除术在超低位直肠癌保肛手术中的应用价值  

Application value of laparoscopic trans-anal sphincterotomy in anus-preserving surgery for ultra-low rectal cancer

作　　者：苏耀荣[1] 李超[1] 何东添 蒋文川 伍颖君[1] SU Yaorong;LI Chao;HE Dongtian;JIANG Wenchuan;WU Yingjun(Department of Gastrointestinal Surgery,Jiangmen Central Hospital,Guangdong,Jiangmen 529030,China)

机构地区：[1]广东省江门市中心医院胃肠外科,广东江门529030

出　　处：《中国医药科学》2021年第8期170-174,共5页China Medicine And Pharmacy

摘　　要：目的探讨腹腔镜下经肛门括约肌间切除术在超低位直肠癌保肛手术中的应用价值。方法选取我院2015年1月至2018年1月超低位直肠癌患者57例作为观察对象,按照治疗方式分为观察组30例、对照组27例。观察组行腹腔镜下经肛门括约肌间切除术,对照组行腹腔镜Miles手术,观察患者手术时间、术中出血量、淋巴结清扫数目、人工肛门排气时间、总住院时间、术后住院时间、病理学分期、肿瘤学预后、肛门功能、Wexner评分以及Kirwan分级。结果观察组的手术时间、术后住院时间、总住院时间均短于对照组以及术中出血量明显少于对照组,差异有统计学意义(P<0.05);两组清扫淋巴结数、术后病理分期比较,差异无统计学意义(P>0.05);两组肿瘤局部复发、转移发生率、死亡率比较,差异无统计学意义(P>0.05);观察组肛门功能恢复优良率为100.00%,Wexner评分(10.08±1.33)分,Kirwan分级1级5例(16.67%),2级12例(40.00%),3级10例(33.33%),4级3例(10.00%)。结论腹腔镜下经肛门括约肌间切除术在超低位直肠癌保肛手术中疗效确切,可以促进患者术后恢复,缩短住院时间,腹腔镜下经肛门括约肌间切除术安全性好,肿瘤根治效果不逊于腹腔镜Miles手术。因此可以将腹腔镜下经肛门括约肌间切除术推荐给具有强烈保肛意愿的低位直肠癌患者,从而有效避免永久性结肠造口,具有较高临床应用价值。Objective To investigate the application value of laparoscopic trans-anal sphincterotomy in anuspreserving surgery for ultra-low rectal cancer.Methods A total of 57 patients with ultra-low rectal cancer admitted to our hospital from January 2015 to January 2018 were selected as the observation objects,and they were divided into the observation group(n=30)and the control group(n=27)according to treatment methods.The observation group was treated with laparoscopic trans-anal sphincterotomy,while the control group was treated with laparoscopic Miles operation.The operation duration,volume of intraoperative hemorrhage,number of lymph node dissection,artificial anus exhaust time,total hospitalization time,postoperative hospitalization time,pathological stage,oncology prognosis,anal function,Wexner score and Kirwan grade of patients were observed.Results The operation duration,postoperative hospitalization time and total hospitalization time,as well as the volume of intraoperative hemorrhage of the observation group were all significantly less than those of the control group,with statistically significant differences(P<0.05).There were no statistically significant differences in the number of lymph nodes and postoperative pathological stage between the two groups(P>0.05).There were no statistically significant differences in the incidences of topical relapse,metastasis and mortality between the two groups(P>0.05).In the observation group,the excellent and good rate of anal function recovery was 100.00%,and Wexner score was(10.08±1.33)points.According to Kirwan classification,there were 5 cases(16.67%)in class 1,12 cases(40.00%)in class 2,10 cases(33.33%)in class 3 and 3 cases(10.00%)in class 4.Conclusion Laparoscopic trans-anal sphincterotomy is effective in anus-preserving surgery for ultra-low rectal cancer,which can promote postoperative recovery and shorten hospitalization time.Laparoscopic trans-anal sphincterotomy is safe,and the therapeutic efficacy of tumor is no worse than that of laparoscopic Miles surgery.T

关 键 词：腹腔镜 经肛门括约肌间切除术 超低位直肠癌 保肛手术 肛门功能 排便功能 

分 类 号：R735.37[医药卫生—肿瘤]