经肛内镜入路对比腹腔镜下完全经腹入路在经括约肌间切除术中的应用研究  

A comparative study of transanal endoscopic approach and completely transabdominal approach in intersphincteric resection

作　　者：乃吉普·阿不都艾尼 徐玺谟 宋海勤 程兮 张森[1] 李健文[1] 郑民华[1] 蔡正昊 冯波[1] NAIJIPU Abuduaini;XU Ximo;SONG Haiqin;CHENG Xi;ZHANG Sen;LI Jianwen;ZHENG Minhua;CAI Zhenghao;FENG Bo(Department of General Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai Minimally Invasive Surgery Center,Shanghai 200025,P.R.China)

机构地区：[1]上海交通大学医学院附属瑞金医院普外科/上海市微创外科临床医学中心,上海200025

出　　处：《中国普外基础与临床杂志》2024年第5期565-570,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的对比经肛内镜入路经括约肌间切除术(transanal endoscopic intersphincteric resection,TaEISR)与完全经腹入路经括约肌间切除术(completely transabdominal approach for intersphincteric resection,CTAISR)治疗超低位直肠癌的围手术期安全性和肿瘤学疗效。方法回顾性分析2022年6月至2023年6月期间在上海交通大学医学院附属瑞金医院接受TaE-ISR或CTA-ISR患者的临床资料,其中38例行TaE-ISR,16例行CTA-ISR。比较2组患者的手术相关指标(包括手术时间、毗邻脏器损伤、保护性造口、留置肛管)、术后恢复及并发症、肿瘤学结果(包括环周切缘阳性率、远端切缘长度、淋巴结获取数目等)。结果TaE-ISR组患者的肿瘤下缘距肛缘距离比CTA-ISR组更低[4.0(3.4,4.5)cm vs 4.9(4.1,5.9)cm)],差异具有统计学意义(P<0.001)。Ta E-ISR组的手术时间更长[(177.18±37.24)min vs(146.25±38.86)min]、留置肛管率更高[97.4%(37/38)vs 56.3%(7/16)]、保护性造口率更高[94.7%(36/38)vs 12.5%(2/16)],经肛取标本率更高[92.1%(35/38)vs 0%(0/16)],术后首次半流质饮食时间更快[4(3,5)d vs 6(5,6)d],差异均有统计学意义(P<0.05)。TaE-ISR组未发生毗邻脏器损伤,而CTA-ISR组有2例患者出现术中毗邻脏器损伤(0%vs 12.5%),差异有统计学意义(P=0.026)。2组患者的术后住院时间、术后首次排气时间、术后并发症Clavien-Dindo分级、吻合口漏和吻合口狭窄发生率、远切缘长度、淋巴结清扫总数及阳性淋巴结数目比较差异均无统计学意义(P>0.05)。所有病例术后标本远端切缘均充足、环周切缘均为阴性。结论TaE-ISR与CTA-ISR均可应用于超低位直肠癌的保肛手术,两者相比TaE-ISR在肿瘤下缘距肛缘距离较近时可能是一种较CTA-ISR更为合理的入路方式。Objective To compare the perioperative safety and oncologic efficacy of transanal endoscopic intersphincteric resection(TaE-ISR)and the completely transabdominal approach intersphincteric resection(CTA-ISR)for the treatment of ultra-low rectal cancer.Methods Clinical data of patients who underwent TaE-ISR or CTA-ISR at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,from June 2022 to June 2023,were retrospectively analyzed.A total of 38 cases of TaE-ISR and 16 cases of CTA-ISR were included.Comparison of surgery-related indexes(including operation time,injury of adjacent organs,protective stoma,and placement of anal tube),postoperative recovery and complications,and oncological results(including positive rate of circumferential resection margin,positive rate of distal resection margin,and number of lymph nodes)were compared between the 2 groups.Results The distance of the lower edge of the tumor from the anal verge was lower in the TaE-ISR group than that in the CTA-ISR group[4.0(3.4,4.5)cm vs.4.9(4.1,5.9)cm,P<0.001].A longer duration of the surgery[(177.18±37.24)min vs(146.25±38.86)min],a higher rate of the anal tube[97.4%(37/38)vs 56.3%(7/16)],a higher rate of protective stoma[94.7%(36/38)vs 12.5%(2/16)],and ahigher rate of transanal specimen extraction[92.1%(35/38)vs 0%(0/16)],faster time to first postoperative semi-liquid diet[4(3,5)d vs 6(5,6)d]were observed in the TaE-ISR group(P<0.05).No adjacent organ injuries occurred in the TaE-ISRgroup,whereas 2 patients in the CTA-ISR group had intraoperative adjacent organ injuries(0%vs 12.5%),the differencewas statistically significant(P=0.026).There was no statistically significant difference between the 2 groups in terms ofpostoperative hospitalization,postoperative time to first flatus,Clavien-Dindo grading of postoperative complications,theincidence of anastomotic leakage and anastomotic stenosis,distal margin distance,the total number of lymph nodescleared,and the number of positive lymph nodes(P>0.05).Postoperative specimens in all cases wer

关 键 词：超低位直肠癌 括约肌间切除术 完全经腹入路 经肛内镜手术 

分 类 号：R73[医药卫生—肿瘤]