经肛拖出式腹腔镜直肠癌前切除术对低位直肠癌患者胃肠动力改变及预后的影响  

Effect of anal draw-out laparoscopic anterior resection of rectal cancer on gastrointestinal motility and prognosis in patients with low rectal cancer

作　　者：高源泽 吕超[1] 黄越海[1] Gao Yuanze;Lyu Chao;Huang Yuehai(Department of Proctology,Chongqing Ninth People1s Hospital,Chongqing 400700,China)

机构地区：[1]重庆市第九人民医院肛肠科,400700

出　　处：《国际外科学杂志》2021年第8期547-553,共7页International Journal of Surgery

摘　　要：目的:探讨低位直肠癌患者经肛拖出式腹腔镜直肠癌前切除术治疗后胃肠动力改变及预后的影响。方法:选择2017年5月—2018年5月在重庆市第九人民医院接受治疗的140例低位直肠癌患者资料,其中男82例,女58例,年龄35~78岁,平均(59.33±9.12)岁。按照手术方式分为观察组(经肛门拖出式全腹腔镜直肠前切除术,70例)和对照组(腹腔镜辅助直肠前切除术,70例)。采用独立样本t检验或χ^(2)检验。比较两组患者手术相关指标、并发症发生情况、液体胃排空及小肠传输能力、胃泌素、胃动素变化,绘制Kaplan-Meier生存曲线比较两组患者的肿瘤无进展生存期(PFS)和总生存期,用Log-rank检验比较两组的PFS和总生存期。结果:观察组手术时间、术中出血量、术后引流量、术后恢复时间均显著低于对照组,术后24 h液体胃排空能力、术后24、48 h小肠传输功能、术后24、48、72 h胃泌素、胃动素水平均显著高于对照组,差异有统计学意义(P<0.05)。观察组和对照组术后2年PFS(85.71%比81.43%)、总生存期(92.86%比90.00%),差异均无统计学意义(P>0.05)。结论:经肛拖出式腹腔镜直肠癌前切除术具有安全性、根治性,不会增加术后并发症,且胃肠功能恢复早于传统腹腔镜辅助直肠癌切除术,有助于改善患者术后生活质量,值得临床推广。Objective:To investigate the effect of rectal draw-out laparoscopic anterior resection on gastrointestinal motility and prognosis in patients with low rectal cancer.Methods:A total of 140 patients with low rectal cancer who received treatment in Chongqing Ninth People′s Hospital from May 2017 to May 2018 were selected,including 82 males and 58 females,aged from 35 to 78 years with an average age of(59.33±9.12)years.According to the operation methods,all patients were divided into observation group(transanal pullout laparoscopic anterior resection of rectal cancer,n=70)and the control group(laparoscopic assisted anterior rectal resection,n=70).Independent sample t test orχ^(2)test were used to compare operation-related indicators,occurrence of complications,changes of fluid gastric emptying,small intestinal transport capacity,gastrin and motilin in 2 groups.Kaplan-meier survival curve was plotted to compare tumor progression-free survival(PFS)and overall survival(OS)in two groups.The two groups of PFS and OS were compared by log-rank test.Results:The operative time,intraoperative blood loss,postoperative drainage volume,and postoperative recovery time of the observation group were lower than those of the control group,the ability of liquid gastric emptying 24 h after operation,small intestine transport function at 24 h and 48 h after operation,the capacity of liquid gastric emptation,intestinal transport function 24 h and 48 h postoperatively,gastrin and motilin levels at 24 h,48 h and 72 h postoperatively were significantly higher than those of the control group,with statistically significant differences(P<0.05).Two years PFS(85.71%vs.81.43%)and OS(92.86%vs.90.00%)after surgery between the observation group and the control group were not statistically significant(P>0.05).Conclusion:The anterior resection of rectal cancer by draw-out laparoscope is safe and radical,without increasing postoperative complications.Moreover,the recovery of gastrointestinal function is earlier than traditional laparoscopic assisted

关 键 词：直肠肿瘤 预后 手术后并发症 经肛拖出式腹腔镜直肠癌前切除术 腹腔镜辅助直肠前切除术 低位直肠癌 胃肠动力 

分 类 号：R735.37[医药卫生—肿瘤]