腹腔镜直肠癌根治术标本取出方法对肛门功能影响的研究

Study on anal function of anal preserving surgery for different method to remove specimens with rectal cancer

目的探讨直肠癌Dixon手术标本不同取出方法对术后肛门功能的影响。方法选择2011年6月至2012年2月间行直肠癌根治术Dixon术式的131例患者为研究对象,根据不同的手术标本取出方法,将患者分为传统开腹组、腹腔镜经腹组、腹腔镜经肛门组和腹腔镜经阴道组。对四组患者术后的临床资料进行前瞻性分析,分别比较前三组患者及第三组中女性患者与第四组患者术后肛门功能的差异。结果术后1个月、3个月、6个月传统开腹组、腹腔镜经腹组、腹腔镜经肛门组肛门功能的优良率分别是73.6%、75.0%和83.3%,79.4%、80.6%和88.9%,88.2%、90.3%和94.4%。腹腔镜经肛门组中女性患者和腹腔镜经阴道组肛门功能的优良率分别为80.0%和71.4%,80.0%和71.4%,90.0%和85.7%,两组相比差异无统计学意义。结论直肠癌Dixon手术标本不同取出方法对术后肛门功能影响的差异无统计学意义,但经自然腔道取出标本的腹腔镜手术有微创优势。

Objective To compare anal function of anal preserving surgery for different method to remove specimens with rectal cancer. Methods Choose 131 patients undergoing rectal cancer surgery during the period of June 2011 to February 2012 in our department. According to the method of removing specimens, patients are divided into four groups, open group, laparoscopic transabdorminal group, laparoscopic peranum group and laparoscopic transvaginal group. The clinical data of the patients were prospectively analyzed and the anal functions were compared between the first three groups, and between the female patients of third group and the forth group. Results The excellent rates of postoperative anal function in the first three groups were 73.6%,75.0% and 83.3% at first month, 79.4%,80.6% and 88.9% at third month,88.2%、90.3% and 94.4% at sixth month. There were no significant in excellent rates of anal function between two groups. The excellent rates of postoperative anal functions in the female patients of third group and the forth group were 80.0% and 71.4% at first month, 80.0% and 71.4% at third month, 90.0% and 85.7% at sixth month. There were no significant in excellent rates of anal function between two groups.Conclusions There were no significant difference of anal function for different method to remove specimens with rectal cancer preserving surgery,but the surgery of removing specimens by natural cavity have significant minimally invasive advantages.