腹腔镜全直肠系膜切除术治疗低位直肠癌的效果分析  

Effect of laparoscopic total mesorectal excision for low rectal cancer

作　　者：张力[1] 林圳滨 范小华[1] 梁学敏[1] 李俊苗[1] ZHANG Li;LIN Zhen-bin;FAN Xiao-hua;LIANG Xue-min;LI Jun-miao(Department of Anorectum,Guangdong Provincial Hospital of Chinese Medicine,Guangzhou Guangdong 510120,China)

机构地区：[1]广东省中医院肛肠科,广东广州510120

出　　处：《局解手术学杂志》2021年第12期1061-1065,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：广东省科学技术厅科技计划项目(粤科规财字[2015]110号广州中医药大学-16)。

摘　　要：目的探讨腹腔镜全直肠系膜切除术治疗低位直肠癌(LRC)患者的近期疗效及远期生存率。方法纳入行腹腔镜全直肠系膜切除术的68例LRC患者为腹腔镜组,选取同期行传统开腹根治术的67例LRC患者为开腹组。比较2组患者围术期指标、术后炎症应激指标、术后并发症、术后生活质量及3年生存率。结果腹腔镜组手术时间较开腹组长(P<0.001),而术中出血量、术后进食时间、术后肛门排气时间、住院时间均显著优于开腹组(P<0.001)。腹腔镜组术后4 d C反应蛋白(CRP)水平较术前升高(P<0.001),腹腔镜组术后4 d白细胞计数(WBC)、CRP水平均优于开腹组(P<0.001)。腹腔镜组术后并发症发生率显著低于开腹组(P=0.035),但2组患者并发症Clavien-Dindo分级比较,差异无统计学意义(P>0.05)。腹腔镜组术后1个月、6个月、1年胃肠生活质量量表(GIQLI)评分均高于开腹组(P<0.05)。Kaplan-Meier分析结果显示,2组患者3年生存率比较,差异无统计学意义(P=0.152)。结论腹腔镜全直肠系膜切除术治疗LRC疗效确切、创伤小、术中出血量低、术后恢复快,可缩短住院时间,减少术后并发症的发生,提高患者生活质量。Objective To investigate the short-term efficacy and long-term survival rate of laparoscopic total mesorectal excision on patients with low rectal cancer(LRC).Methods A total of 68 patients with LRC who underwent laparoscopic total mesorectal excision were included into the laparoscopic group,and 67 patients with LRC who underwent traditional radical laparotomy during the same period were selected into the laparotomy group.The perioperative indicators,postoperative inflammatory and stress indexes,postoperative complications,postoperative quality of life and 3-year survival rate of the two groups were compared.Results The operation time of the laparoscopic group was longer than that of the laparotomy group(P<0.001),the intraoperative blood loss,postoperative feeding time,postoperative anal exhaust time,and hospital stay were significantly less/shorter than those of the laparotomy group(P<0.001).The C-reactive protein(CRP)level 4 days after operation in the laparoscopic group was higher than that before operation(P<0.001),the levels of white blood cell count(WBC)and CRP 4 days after operation in the laparoscopic group were lower than those in the laparotomy group(P<0.001).The incidence of postoperative complications in the laparoscopic group was significantly lower than that in the laparotomy group(P=0.035),but there was no statistically significant difference in the Clavin-Dindo classification of complications between the two groups(P>0.05).The gastrointestinal quality of life index(GIQLI)scores in the laparoscopic group 1 month,6 months and 1 year after operation were higher than those in the laparotomy group(P<0.05).Kaplan-Meier analysis showed that there was no statistically significant difference in the 3-year survival rate between the two groups(P=0.152).Conclusion Laparoscopic total mesorectal resection for LRC has definite efficacy,small trauma,low intraoperative blood loss,and quick postoperative recovery.It can shorten the hospital stay,reduce the occurrence of postoperative complications,and improve the

关 键 词：低位直肠癌 腹腔镜全直肠系膜切除术 炎症应激反应 并发症 生存率 

分 类 号：R735.37[医药卫生—肿瘤]