腹腔镜辅助经肛内镜结直肠癌根治术的安全性及可行性

Safety and feasibility of macroscopic-assisted transvaal endoscopic surgery for colon cancer

目的分析并探讨腹腔镜辅助经肛内镜结直肠癌根治术的临床效果及安全性。方法选取2009年3月至2014年4月结直肠癌患者80例。根据治疗方法将患者分为腹腔镜伴肛内镜组和传统开腹组,每组40例。使用统计学软件SPSS 19.0分析,手术时间、术中出血量、排气时间、活动时间、住院时间采取t检验,局部复发率和远处转移率以及并发症发生率采取卡方检验,以P〈0.05为差异有统计学意义。结果腹腔镜伴肛内镜组手术时间长于传统开腹组（t=13.72,P〈0.05）,术中出血量明显少于传统开腹组（t=32.03,P〈0.05）,术后首次排气时间（t=38.91,P〈0.05）、下床活动时间（t=15.06,P〈0.05）、住院时间短于传统开腹组（t=11.63,P〈0.05）差异均有统计学意义。局部复发率（χ~2=0.18,P〉0.05）和远处转移率（χ~2=0.26,P〉0.05）;并发症发生率：腹腔镜伴肛内镜组为22.5%（9/40）,传统开腹组为20.0%（8/40）,（χ~2=0.07,P〉0.05）,两组差异无统计学意义。结论腹腔镜辅助经肛内镜结直肠癌根治术安全性较高,具有一定临床可行性,在未明显影响根治效果前提下对患者创伤更小,患者术后恢复更快,值得推广。

Objective To analyze the clinical efficacy and safety of anal macroscopic-assisted endoscopic resection for colon cancer. Methods Eighty patients with colon cancer who were treated at this hospital from March 2009 to April 2014 were enrolled in the study. The 80 patients were divided into a macroscopic group treated with an anal endoscope and a traditional open surgery group,with 40 patietns in each group. Statistical analysis was performed by using SPSS 19. 0 software. Operative time,blood loss,exhaust time,activity time,and hospitalization time were examined by Student＇s t test,and the rates of local recurrence,distant metastasis,and complication were examined by the Chi-square test. P〈0. 05 was considered statistically significant. Results The time of macroscopic group with anal endoscopic procedure is longer than that of the traditional protoplasm group（ t = 13. 72,P〈0. 05）. The bleeding volume was less than that of the conventional protoplasm group（ t = 32. 03,P〈0. 05）. The postoperative first exhaust time（ t = 38. 91,P〈0. 05）,activity time out of bed（ t = 15. 06,P〈0. 05）,length of hospital stay were short in the traditional protoplasm group（ t = 11. 63,P〈0. 05）. The complication rate of the macroscopic group with an anal endoscopic procedure was 22. 5%（ 9 /40） and that of the conventional protoplasm group was 20. 0%（ 8 /40） and（ χ~2= 0. 07,P〈0. 05）. The difference between the two groups was not statistically significant. Conclusions Macroscopic-assisted transvaal endoscopic resection of colon cancer is highly safe and feasible in clinical practice.