腹腔镜改良Parks手术与开腹手术治疗低位直肠癌患者的效果比较  

Effect Comparison of Laparoscopic Modified Parks Surgery and Open Surgery in the Treatment of Patients with Low Rectal Cancer

作　　者：章志城 ZHANG Zhicheng(Datian County General Hospital,Datian 366100,China)

机构地区：[1]大田县总医院,福建大田366100

出　　处：《中外医学研究》2023年第27期1-5,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:比较腹腔镜改良经肛门结肠肛管吻合术(Parks手术)与开腹手术治疗低位直肠癌患者的效果。方法:选择2017年3月—2019年12月大田县总医院收治的95例低位直肠癌患者作为研究对象,根据手术方法的不同分为腹腔镜组(腹腔镜下改良Parks手术,51例)和开腹组(开腹手术,44例)。比较两组手术效果、手术相关指标、排便功能[低位前切除综合征(low-level anterior resection syndrome,LARS)评分]、肛门功能[肛管静息压(anal canal resting pressure,ARP)、肛管最大收缩压(anal canal maximum systolic pressure,AMSP)及直肠最大耐受容量(rectum maximum tolerated volume,RMTV)]及免疫功能[免疫球蛋白G(immunoglobulin G,IgG)、免疫球蛋白A(immunoglobulin A,IgA)及免疫球蛋白M(immunoglobulin M,IgM)]变化,预后(术后3年生存情况)及并发症发生情况。结果:两组手术总有效率、并发症总发生率及3年生存率比较,差异无统计学意义(P>0.05)。腹腔镜组术中出血量少于开腹组,手术时间长于开腹组,肛门排气时间、住院时间短于开腹组,差异有统计学意义(P<0.05)。术后3个月,两组LARS评分及ARP、AMSP、RMTV低于术前,且腹腔镜组LARS评分及AMSP低于开腹组,RMTV高于开腹组,差异有统计学意义(P<0.05);但两组术后3个月ARP比较,差异无统计学意义(P>0.05)。术后1周,开腹组IgG、IgA及IgM水平均低于术前,但腹腔镜组高于开腹组,差异有统计学意义(P<0.05)。结论:相比开腹手术,腹腔镜改良Parks手术治疗低位直肠癌患者,可改善排便功能及肛门功能,促进术后肛门排气,且对免疫功能的影响较小,但两种术式手术效果、3年生存期及并发症相当。Objective:To compare the effect of laparoscopic modified trans-anal colon-anus anastomosis(Parks surgery)and open surgery in the treatment of patients with low rectal cancer.Method:A total of 95 patients with low rectal cancer who admitted to Datian County General Hospital from March 2017 to December 2019 were selected as the research objects,they were divided into laparoscopic group(laparoscopic modified Parks surgery,51 cases)and laparotomy group(open surgery,44 cases)according to different surgical methods.The surgical effect,surgical related indicators,changes of defecation function[low-level anterior resection syndrome(LARS)score],anal function[anal canal resting pressure(ARP),anal canal maximum systolic pressure(AMSP)and rectum maximum tolerated volume(RMTV)]and immune function[immunoglobulin G(IgG),immunoglobulin A(IgA)and immunoglobulin M(IgM)],prognosis(3-year survival after surgery)and complications were compared between two groups.Result:There were no significant differences in the total effective rate,total incidence of complications and 3-year survival rate between two groups(P>0.05).The intraoperative blood loss in the laparoscopic group was less than that in the laparotomy group,the surgical time was longer than that in the laparotomy group,and the anal exhaust time and hospitalization time were shorter than those in the laparotomy group,the differences were statistically significant(P<0.05).At 3 months after surgery,the LARS score,ARP,AMSP and RMTV of two groups were lower than those before surgery,and the LARS score and AMSP in the laparoscopic group were lower than those in the laparotomy group,and the RMTV was higher than that in the laparotomy group,the differences were statistically significant(P<0.05);however,there was no significant difference in ARP between two groups at 3 months after surgery(P>0.05).One week after surgery,the levels of IgG,IgA and IgM in the laparotomy group were lower than those before surgery,but those in the laparoscopic group were higher than those in the laparotomy

关 键 词：腹腔镜 改良经肛门结肠肛管吻合术 低位直肠癌 排便功能 3年生存期 

分 类 号：R735.37[医药卫生—肿瘤]