经肛门内镜微创手术与传统开腹手术治疗直肠癌的效果观察  

Effect of transanal endoscopic microsurgery and traditional laparotomy on patients with rectal cancer

作　　者：彭建亮 孙永安 杨嘉甫 袁之路 张忠宝 梁本甲 张志敏 Peng Jianliang;Sun Yongan;Yang Jiafu;Yuan Zhilu;Zhang Zhongbao;Liang Benjia;Zhang Zhimin(General Surgery,The Third People's Hospital of Liaocheng,Liaocheng 252000,China;Emergency Department,The Third People's Hospital of Liaocheng,Liaocheng 252000,China;Operating Room,The Third People's Hospital of Liaocheng,Liaocheng 252000,China;Gastrointestinal Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Department of Neonatology,The People's Hospital of Liaocheng,Liaocheng 252000,China)

机构地区：[1]聊城市第三人民医院普外科,聊城252000 [2]聊城市第三人民医院急症科,聊城252000 [3]聊城市第三人民医院手术室,聊城252000 [4]山东第一医科大学附属省立医院胃肠外科,济南250021 [5]聊城市人民医院新生儿科,聊城252000

出　　处：《国际医药卫生导报》2023年第9期1218-1222,共5页International Medicine and Health Guidance News

基　　金：国家自然科学基金(81802417)。

摘　　要：目的探讨经肛门内镜微创手术(TEM)与传统开腹手术治疗直肠癌的效果及对患者术后胃肠功能恢复的影响。方法本研究为随机对照试验。选择2019年5月至2022年5月在聊城市第三人民医院进行治疗的80例直肠癌患者为研究对象,随机分为观察组和对照组,各40例。观察组男26例,女14例,年龄(49.25±7.63)岁,行TEM治疗;对照组男24例,女16例,年龄(50.63±7.24)岁,行传统开腹手术治疗。比较两组手术各项指标、手术前后胃肠激素[胃动素、胃泌素]水平、术后胃肠功能恢复情况、手术前后肛门功能情况以及并发症发生情况。统计学方法采用独立样本t检验、配对t检验、χ^(2)检验。结果观察组手术时间[(60.57±11.29)min比(143.35±32.54)min]、出血量[(62.93±15.43)ml比(137.69±36.47)ml]、住院时间[(7.45±1.26)d比(12.37±3.13)d]均优于对照组(均P<0.001),两组淋巴结清扫数量、标本长度比较差异均无统计学意义(均P>0.05)。手术后两组胃动素、胃泌素均低于手术前(均P<0.05),但术后观察组胃动素[(253.16±30.57)ng/L比(219.25±29.52)ng/L]、胃泌素水平[(141.24±11.17)μmol/L比(103.65±10.43)μmol/L]均高于对照组(均P<0.001)。手术后观察组胃肠功能恢复情况均优于对照组(均P<0.001)。手术后,两组大便失禁严重度(Wexner)评分均高于手术前,肛管静息压(ARP)、肛管最大收缩压(MSP)均低于手术前,差异均有统计学意义(均P<0.05);观察组Wexner评分低于对照组[(7.23±1.56)分比(9.58±1.94)分,t=5.970,P<0.001],两组ARP、MSP水平比较差异均无统计学意义(均P>0.05)。观察组并发症总发生率低于对照组[5.00%(2/40)比20.00%(8/40)],两组比较差异有统计学意义(χ^(2)=4.114,P=0.043)。结论TEM与传统开腹手术均可有效治疗直肠癌,其中TEM对胃肠激素水平影响较小,更利于缩短恢复时间,进一步促进胃肠功能与肛门功能恢复,且术后并发症发生率较低,临床应用价值较高。Objective To investigate the effects of transanal endoscopic microsurgery(TEM)and traditional laparotomy on the postoperative recovery of gastrointestinal function in patients with rectal cancer.Methods It was a randomized controlled trial.A total of 80 patients with rectal cancer treated in The Third People's Hospital of Liaocheng from May 2019 to May 2022 were selected as research objects and were randomly divided into an observation group and a control group,with 40 cases in each group.In the observation group,there were 26 males and 14 females,aged(49.25±7.63)years;in the control group,there were 24 males and 16 females,aged(50.63±7.24)years.The observation group received TEM,and the control group received traditional laparotomy.The surgery related indexes,levels of gastrointestinal hormones(motilin and gastrin)before and after surgery,postoperative gastrointestinal function recovery,anal function before and after surgery,and incidences of complications were compared between the two groups.Independent sample t test,paired t test,andχ^(2) test were used for statistical analysis.Results The operation time[(60.57±11.29)min vs.(143.35±32.54)min],blood loss[(62.93±15.43)ml vs.(137.69±36.47)ml],and hospital stay[(7.45±1.26)d vs.(12.37±3.13)d]in the observation group were all better than those in the control group(all P<0.001),but there were no statistically significant differences in the number of lymph nodes dissected and length of specimens between the two groups(both P>0.05).The motilin and gastrin levels in both groups after surgery were lower than those before surgery(all P<0.05);the levels of motilin[(253.16±30.57)ng/L vs.(219.25±29.52)ng/L]and gastrin[(141.24±11.17)μmol/L vs.(103.65±10.43)μmol/L]in the observation group were higher than those in the control group(both P<0.001).The recovery of gastrointestinal function in the observation group was better than that in the control group(P<0.001).After surgery,the Wexner scores of fecal incontinence severity of the two groups were higher than thos

关 键 词：直肠癌 经肛门内镜微创手术 传统开腹手术 胃肠功能 肛门功能 

分 类 号：R735.37[医药卫生—肿瘤]