经耻骨上小切口会阴联合直肠切除的效果观察

Clinical effectiveness of resection of rectum combined with perineum via suprapubic minimal incision

目的探讨经耻骨上小切口会阴联合直肠切除治疗直肠下段癌的临床效果。方法比较经耻骨上小切口会阴联合直肠切除70例（A组）和传统Miles术71例（B组）的腹部切口平均长度、腹部切口至造口平均距离、切口感染率、术中清除淋巴结个数。结果A、B两组腹部切口平均长度为（5．5±0．5）cm和（15．0±2．0）cm，P〈0．01；A、B两组腹部切口至造口平均距离为（13．6±2．2）cm和（8．0±2．1）cm，P〈0．01；A、B两组切口感染率为2．9％和12．7％，P〈0．05；A、B两组术中清除淋巴结平均个数比较，P〉0．05。结论A组方法治疗低位直肠癌，能达到Miles清扫范围、缩小腹部切口长度、增加腹部切口至造口距离，减少切口感染率，其微创程度接近腹腔镜下Miles手术。

objective To investigate the clinical effectiveness of treating the cancer of rectum by resection of rectum combined with perineona via a suprapubic minimal incision. Methods Two groups were established： group of resection of recturn combined with perinetnn via a suprapubic minimal incision （group A,n= 70） ;Miles operation group （group B, n = 71）. The average length of abdominal incision, average distance of abdominal incision to sigmoid colon storm, infection rate of abdominal incision, the average amount of removed lymph nodes were compared between group A and group B. Results The average length of abdominal incision in groups A and B was （5. 5 ± 0. 5） cm and （15. 0 ± 2. 0） cm respsctively,P〈0. 01. Average distance of abdominal incision to sigmoid colon stoma in groups A and B was （13. 6 ± 2. 2 ） cm and （8. 0 ± 2. 1） cm respectively, P〈 0. 01. Infection rate of abdominal incision in groups A and B was 2. 9 % and 12. 7 % respectively, P〈0. 05. The average amount of removed lymph nodes in groups A and B was （16. 0 ± 1.0） and （16. 0 ± 1. 1 ） respectively, P〉0. 05. Conclusion Removing rectum combined with perineum via a suprapubic minimal incision could achieve the same scope of lymph node cleared in Miles and decrease the average length of abdominal incision, extend average distance of abdominal incision to sigmoid colon stoma, and decrease infection rate of abdominal incision significandy. Its traumatic degree were closed to Miles under laparoscopy.