腹腔镜下经肛拖出直肠癌根治术超低位保肛的临床研究

Clinical study on laparoscopic transanal pull-through with anal sphincter preservation in the treatment of ultra-low rectal cancer

目的探讨腹腔镜下经肛拖出直肠癌根治术超低位保肛的可行性、安全性、根治性及短期临床疗效。方法回顾我院收治的127例超低位直肠癌,运用腹腔镜经肛拖出直肠癌根治术行超低位保肛65例(腹腔镜组)、直肠癌超低位前切除术62例(开腹组),比较两组术中、术后及愈后各项指标。结果腹腔镜组术中出血量及术后肠道功能恢复时间、止痛药物使用时间、住院时间均优于开腹组(P<0.05)。两组手术时间、清扫淋巴结数量、术后吻合口漏、吻合口狭窄、复发、转移、大便失禁和总生存率各项差异无统计学意义(P>0.05)。结论腹腔镜下经肛拖出直肠癌根治术超低位保肛符合肿瘤学根治性原则,安全可行,术后恢复快,适合用于超低位直肠癌保肛。

Objective To explore the feasibility,safety,radical cure and short-term outcome of laparoscopic transanal pull-through（LTPT） with anal sphincter preservation in the treatment of ultra-low rectal cancer.Methods Sixty-five patients of ultra-low rectal cancer（5 cm from the anal verge） were subjected to LTPT with anal sphincter preservation,whereas sixty-two patients were subjected to ultra-1ow anterior resection（ULAR）.The operative procedures,clinicopathological data and short-term outcomes were collected and compared.Results It had significant differences between the two groups in terms of bleeding,the time for intestinal functional recovery and acesodynes used,length of stay（P〈0.05）.No significant differences were observed between the two groups in terms of the operation time,the number of lymph node,stomal leak,stenostomia,recurrence,metastasis,fecal incontinence and overall survival rate（P〉0.05）.Conclusion LTPT with anal preservation can strictly follow oncologic principle,which is a safe and feasible approach to the surgical treatment of ultra-low rectal cancer,and has benefits of much less trauma and earlier postoperative recovery.