taTME联合改良Bacon术治疗低位直肠癌30例近期疗效分析  

Short-term outcomes of transanal total mesorectal excision combined with modi⁃fied Bacon’s procedure for treating low rectal cancer:an analysis of 30 cases

作　　者：符智勇 范雨诗 郭庆 杨选华[1] 周冬兵[1] 滕庆 黄海霞 朱永飞 敬荣 任明扬[1] Fu Zhiyong;Fan Yushi;Guo Qing;Yang Xuanhua;Zhou Dongbing;Teng Qing;Huang Haixia;Zhu Yongfei;Jing Rong;Ren Mingyang(Department of Gastrointestinal Surgery,The Affiliated Nanchong Central Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China)

机构地区：[1]川北医学院附属南充市中心医院胃肠外科,四川南充637000

出　　处：《结直肠肛门外科》2022年第1期51-55,共5页Journal of Colorectal & Anal Surgery

基　　金：国家自然科学基金资助项目(81401927);四川省医学科研课题计划(S15049);南充市市校科技战略合作基金(19SXHZ0452)。

摘　　要：目的探讨经肛全直肠系膜切除术(taTME)联合改良Bacon术治疗低位直肠癌的近期疗效。方法回顾性分析川北医学院附属南充市中心医院2020年3月至2021年8月行taTME的74例低位直肠癌患者的临床资料,根据是否联合行改良Bacon术分为观察组(n=30,行taTME联合改良Bacon术)和对照组(n=44,行taTME一期吻合术)。比较两组术后并发症发生情况、手术相关指标(包括手术时间、术中出血量、吻合口距肛缘距离、术中并发症、预防性造口、中转开腹)、病理学结果(包括环周切缘阳性率、近端切缘阳性率、远端切缘阳性率、系膜完整度、淋巴结收获数目)。结果两组均顺利完成手术,无中转开腹,无术中严重并发症。观察组吻合口距肛缘距离均为0 mm,对照组的中位距离为22.5(10.0,30.0)mm。对照组有5例行预防性回肠造口术,观察组无行预防性回肠造口术病例。两组手术时间、术中出血量、预防性回肠造口率比较差异均无统计学意义(均P>0.05)。两组环周切缘、近端切缘、远端切缘均为阴性,系膜均完整;观察组中位淋巴结收获数目为13.5(6.8,20.3)枚,对照组相应为16.0(11.3,22.5)枚,组间比较差异无统计学意义(P>0.05)。两组均无术后吻合口出血、吻合口狭窄病例;观察组无外置肠管回缩/坏死病例;观察组的总体并发症发生率低于对照组(P<0.05),两组吻合口相关并发症发生率比较差异无统计学意义(P>0.05)。结论taTME联合改良Bacon术的总体并发症发生率低于taTME一期吻合术,在手术时间、术中出血量及病理学结果等方面与taTME一期吻合术相当,临床应用安全、可行。Objectives To analyze the short-term outcomes of transanal total mesorectal excision(taTME)combined with modi⁃fied Bacon’s procedure for treating low rectal cancer.Methods This was a retrospective analysis of 74 patients with low rec⁃tal cancer treated with taTME at the Nanchong Central Hospital—the Affiliated Hospital of North Sichuan Medical College be⁃tween March 2020 and August 2021.Patients were divided into the treatment group(n=30,received taTME combined with modi⁃fied Bacon’s procedure)and the control group(n=44,received taTME and one-stage anastomosis).The followings were com⁃pared between the two groups:postoperative complications,operation time,intraoperative blood loss,distance between the anasto⁃motic site and the anal margin,intraoperative complications,prophylactic stoma,conversion to laparotomy,circumferential resec⁃tion margin positive rate,proximal resection margin positive rate,distal resection margin positive rate,membrane integrity,and lymph node yield.Results All surgeries were uneventful,and no case were converted to open operation.There were no severe intraoperative complications.The median distance between the anastomotic site and the anal margin was 0 mm for the treatment group and 22.5(10.0,30.0)mm for the control group.Five patients in the control group and none in the treatment group had pro⁃phylactic stoma.The two groups did not differ significantly in operation time,intraoperative blood loss,and prophylactic stoma rate(P>0.05).All circumferential,proximal,and distal resection margins were negative,and membrane integrity was maintained in all cases.Median lymph node yield was 13.5(6.8,20.3)for the treatment group and 16.0(11.3,22.5)for the control group,with no sig⁃nificant between-group difference(P>0.05).There was no occurrence of postoperative anastomotic bleeding and anastomotic stenosis for both groups,and no occurrence of intestinal canal retraction or necrosis for the treatment group.The overall incidence of com⁃plications was significantly lower in t

关 键 词：低位直肠癌 经肛全直肠系膜切除术 改良BACON术 

分 类 号：R735.37[医药卫生—肿瘤]