腹腔镜折刀位直肠癌柱状切除术18例临床分析

Laparoscopic cylindrical resection of rectal cancer with jackknife position

目的总结腹腔镜折刀位直肠癌柱状切除术的临床应用效果。方法 2011年7月至2013年4月共完成进展期直肠癌腹腔镜下折刀位柱状切除术18例(柱状切除术组),同期完成腹腔镜下直肠癌miles术24例(miles术组)。比较2组在手术安全性方面的情况。采用SPSS14.0软件进行统计学分析。计数资料采用χ2检验,计量资料采用t检验,以P<0.05为差异有统计学意义。结果两组患者在年龄、性别、术前化疗数、组织分化及临床分期方面差异无统计学意义(P>0.05),具可比性。柱状切除术组的手术时间为(205.33±27.36)min,显著多于miles术组的(178.25±18.54)min;术中出血量柱状切除术组明显少于miles术组,分别为(98.47±36.46)ml和(189.23±56.30)ml;柱状切除组未见有术中穿孔,而miles术组中术中穿孔者3例;柱状切除组未见有术后环周切缘阳性病例,而miles术组中术后环周切缘阳性3例。以上4项两组差异均有统计学意义(t值=2.669、2.489、4.650,χ2值=4.390,P<0.05)。在术后肠功能恢复时间、摘取淋巴结数、术后引流量和术后并发症总发生率等方面两组差异无统计学意义(P>0.05)。柱状切除术组术后1例(5.6%),miles组术后4例(16.7%)出现复发及转移情况,二者差异无统计学意义(χ2=0.051 8,P>0.05)。两组患者暂未见有死亡病例。结论腹腔镜下折刀位直肠癌柱状切除术可以减少术中出血,更多的切除直肠癌周围组织,有效减少术中穿孔,保证环周切缘阴性率。

Objective To summarize the clinical outcome of laparoscopic cylindrical resection of rectal cancer with jackknife position. Methods From July 2011 to April 2013, 18 patients with advanced rectal cancer received laparoscopic cylindrical resection with jackknife position （cylindrical resection group）. During the corresponding time period, 24 patients received laparoscopic abdominoperineal resection of rectal cancer （MILES group） in Fushun Mining Bureau General Hospital. Clinical data on the safety were compared between the 2 groups. Statistical analysis was performed by the chi-square test and Student＇ s t test, using SPSS14.0 software. A P value 〈 0.05 was considered statistically significant. Results The data of 42 patients in the two groups were compared, including age, gender, preoperative chemotherapy, differentiation and clinical staging of tumors（P 〉 0.05 ）. In the cylindrical resection group, operation time was （：205.33 ~ 27.36 ） minutes, which was significantly longer than （ 178.25 ＋ 18.54 ） minutes in the MILES group. However, blood loss of （98.47 ＋ 36.46） ml in the cylindrical resection group was significantly less than （189.23 ~56.30） ml in the MILES group. There was no intraoperative perforation in the cylindrical resection group, but 3 patients in the MILES group had intraoperative perforation. No postoperative positive circumferential margin was found in the cylindrical resection group, but 3 patients had positive circumferential margin in the MILES group（t value = 2. 669, 2. 489, 4. 650, X2 value = 4. 390, P 〈 0.05, respectively）. There was no significant difference in time for intestinal functional recovery, lymph nodes, postoperative drainage and incidence of postoperative complications between the two groups （F 〉 0.05）. Onepatiem（5.6% ） in the cylindrical resection group and 4 pateints（ 16.7% ） in the MILES group had recurrence and metastasis of rectal cancer（x2 = 0. 051 8, P 〉 0.05）. Conclusions Less blood loss, sufficient resection of circumferential tissue, reduced intraoperative perforation and satisfactory circumferential margin-negative rate could be achieved by laparoscopic cylindrical resection with jackknife position.