适形切除保肛术与经括约肌间直肠切除术治疗低位直肠癌患者的临床效果对比

Comparison of the Clinical Effect of Conformal Sphincter Preservation Operation and Transsphincter Interrectal Resection in Patients with Low Rectal Cancer

目的:分析对比适形切除保肛术(CSPO)与经括约肌间直肠切除术在低位直肠癌患者中的治疗效果。方法:选取2021年3月—2023年3月枣庄市立医院胃肠肛肠外科收治的96例低位直肠癌患者,按随机数字表法分为两组,各48例。对照组行经括约肌间直肠切除术,观察组行CSPO,随访至术后3个月。对比两组手术相关指标、肛门功能、生活质量、并发症。结果:两组术中出血量、淋巴结清扫数目相比,差异均无统计学意义(P>0.05)。观察组手术时间为(171.63±11.57)min、肛门排气时间为(2.26±0.75)d、住院时间为(6.21±1.35)d,分别短于对照组的(203.58±14.29)min、(4.71±1.24)d、(8.69±1.84)d,观察组的并发症发生率为4.17%(2/48),低于对照组的18.75%(9/48),差异均有统计学意义(P<0.05)。术前,两组直肠最大耐受容量(MTV)、直肠静息压(RRP)、肛管最大收缩压(MSP)与世界卫生组织生存质量测定量表简表(WHOQOL-BREF)各维度评分相比,差异均无统计学意义(P>0.05);术后,观察组MTV为(181.50±17.25)mL、MSP为(129.85±10.45)mmHg,WHOQOL-BREF各维度评分分别为(70.21±3.62)、(75.83±4.29)、(77.49±3.46)、(76.29±3.98)分,分别高于对照组的(159.71±15.82)mL、(113.42±8.31)mmHg和(65.38±2.97)、(68.96±3.01)、(69.35±2.97)、(67.42±3.28)分,观察组RRP为(8.48±1.46)mmHg,低于对照组的(10.21±2.06)mmHg,差异均有统计学意义(P<0.05)。结论:与经括约肌间直肠切除术相比,CSPO具有更短的手术时间,能够最大限度的保存患者肛门功能,促进患者术后恢复,提升生活质量,且并发症较少。

Objective:To analyze and compare the therapeutic effects of conformal sphincter preservation operation(CSPO)and transsphincter interrectal resection in patients with low rectal cancer.Method:A total of 96 patients with low rectal cancer admitted to the Gastroenterology and Anorectal Surgery Department of Zaozhuang Municipal Hospital from March 2021 to March 2023 were selected and divided into two groups according to random number table method,with 48 patients in each group.The control group underwent transsphincter interrectal resection,and the observation group underwent CSPO.Follow-up was performed until 3 months after surgery.Operation-related indexes,anal function,quality of life and complications were compared between the two groups.Result:There were no statistically significant differences in intraoperative bleeding volume and number of lymph node dissection between the two groups(P>0.05).The operation time in the observation group was(171.63±11.57)min,the anal exhaust time was(2.26±0.75)d and the hospital stay was(6.21±1.35)d,which were shorter than(203.58±14.29)min,(4.71±1.24)d and(8.69±1.84)d in the control group,respectively,the incidence of complications in the observation group was 4.17%(2/48),lower than 18.75%(9/48)in the control group,the differences were statistically significant(P<0.05).Before surgery,there were no statistically significant differences in the maximum toler-able volume(MTV),rectal resting pressure(RRP),and maximum squeeze pressure(MSP)and the various dimensions of the World Health Organization quality of life scale(WHOQOL-BREF)between the two groups(P>0.05);after surgery,the MTV of the observation group was(181.50±17.25)mL,the MSP was(129.85±10.45)mmHg,the scores of each dimension in the WHOQOL-BREF were(70.21±3.62),(75.83±4.29),(77.49±3.46),and(76.29±3.98)points,respectively,which were higher than(159.71±15.82)mL,(113.42±8.31)mmHg,(65.38±2.97),(68.96±3.01),(69.35±2.97),and(67.42±3.28)points in the control group,the RRP of the observation group was(8.48±1.46)mmHg,lower than(10.21±2.06)mmHg of the control group,the differences were statistically significant(P<0.05).Conclusion:Compared with transsphincter interrectal resection,CSPO has a shorter operation time,can maximize the preservation of anal function,promote postoperative recovery of patients,improve quality of life,and fewer complications.