中低位直肠癌超高热切除技术临床研究

Clinical application of ultrahyperpyrexia dissection technique in middle-lower rectal cancer

目的探讨高频电刀超高热游离技术在直肠癌全系膜切除（total mesorectal excision,TME）术中应用的安全性、有效性及其肿瘤学预后意义。方法对2007年1月~2009年6月该院普外科连续99例中低位进展期直肠癌根治术采用全程高频电刀超高热游离技术（A组）,腹、骶前、会阴部全程高频电刀超高热游离（ab-dominoperineal resection,APR,37例;anterior resection,AR,62例）;与同期连续121例中低位进展期直肠癌根治术采用传统解剖刀剪锐性游离技术（B组）,腹、骶前、会阴部游离操作采用解剖刀剪技术（abdominoperinealresection,APR,52例;anterior resection,AR,69例）患者的临床资料进行回顾性分析。结果 A、B两组间术中出血量、手术时间、骶前引流总量、淋巴结检出数、3年局部复发率和远处复发率均差异存在显著性（P〈0.05）;会阴切口感染率、腹部切口感染率均差异无显著性（P〉0.05）。结论高频电刀超高热游离技术在中低位直肠癌根治性切除术中具有安全、高效和降低癌复发的优点,该技术值得推广。

【Objective】To investigate clinical safety,efficacy,and oncologic prognostic value of high-frequency electrotome ultrahyperpyrexia dissection techniques＇ TME in the advanced middle-lower rectal cancer.【Methods】 99 consecutive patients with advanced middle-lower rectal cancer recruited from January 2007 to June 2009 in our hospital underwent high-frequency electrotome ultrahyperpyrexia dissections（case group）.Among these patients,37 underwent abdominoperineal resections（APR,n =37） and 62 underwent anterior resections（AR,n =62）.During the same period,121 consecutive patients with advanced middle-lower rectal cancer underwent conventional sharp dissections（control group）,including 52 patients with APR and 69 with AR.【Results】Patients treated with high-frequency electrotome ultrahyperpyrexia dissection technique demonstrated significant reduction in the blood loss during surgery,operation duration,amount of fluid drained from anterior sacrum,and 3-year-recurrent rate of regional and distance compared to the patients treated with conventional sharp dissections（P 0.05）.There was no significant difference in the wound infections in the abdominal and perineal location incisions between the two groups（P 0.05）.【Conclusion】High-frequency electrotome ultrahyperpyrexia dissection technique is safe and effective in the treatment of advanced middle-lower rectal cancer.Using this technique also reduces tumor recurrence.Therefore the technique is worthy to widely spread.