腹腔镜与开放经腹括约肌间切除术治疗低位直肠癌的近期疗效比较

Short-term efficacy comparison of laparoscopic versus open transabdominal intersphincteric resection for low rectal cancer

目的比较腹腔镜与开放经腹括约肌间切除术（ISR）治疗低位直肠癌的近期疗效。方法回顾性分析2005年1月至2015年1月间福建医科大学附属协和医院行腹腔镜或开放经腹ISR治疗的246例低位直肠癌患者的临床病理资料。采用R语言2.8.1软件对患者通过倾向性评分法进行1∶1匹配，匹配变量包括患者性别、年龄、ASA评分、新辅助放化疗与否、病理T分期、病理N分期及肿瘤分化程度。最终行腹腔镜经腹ISR（腹腔镜组）和开放经腹ISR（开放组）治疗的各74例患者纳入本研究。比较两组患者的近期疗效及肛门功能情况。结果两组均无围手术期死亡病例。腹腔镜组较开放组的手术时间延长[ （236±45）min比（200±46）min，P= 0.000]、中位术中出血量减少[50（10～ 200）ml比100（20～ 400）ml，P= 0.000]及住院时间缩短[（7.8±2.4）d比（10.5±6.9）d，P= 0.002]。腹腔镜组和开放组总并发症的发生率分别为17.6% （13/74）和28.4% （21/74），差异无统计学意义（P= 0.118）。腹腔镜组与开放组相比，除肺部感染发生率低[4.1%（3/74）比13.5%（10/74），P= 0.042]外，两组吻合口瘘和吻合口狭窄等其他并发症发生率及严重程度的差异均无统计学意义（均P 〉 0.05）。全组患者平均随访52.0月，对完成造口关闭的102例经腹ISR患者进行肛门功能评价，结果显示，腹腔镜组和开放组患者中分别87.1% （54/62）和87.5% （35/40）控粪良好，两组差异无统计学意义（P= 0.066）。结论与开放经腹ISR相比，腹腔镜经腹ISR安全可行，且具有创伤小、恢复快的优点，值得临床进一步推广应用。

Objective To compare the short-term efficacy of laparoscopic and open transabdominal intersphincteric resection （ISR） for low rectal cancer. Methods Clinieopathological data of 246 patients with low rectal cancer undergoing transabdominal ISR in our department from January 2005 to January 2015 were retrospectively analyzed. According to gender, age, ASA score, neoadjuvant chemoradiotherapy or not, pathological T stage, pathologic N stage, and tumor differentiation, propensity score matching was performed by R plug-in（version 2.8.1 ）. Finally, 74 cases treated by laparoscopic transabdominal ISR （laparoscopic group） and 74 cases by open transabdominal ISR （open group） were enrolled. Short-term efficacy and anal function were compared between two groups. Results No perioperative death was found in the two groups. Compared to open group, laparoscopic group had longer operation time [ （236± 45） minutes vs. （200 ±46） minutes, P = 0.000 ], less median blood loss [50 （10 to 200） ml vs. 100 （20 to 400） ml, P=0.000] and shorter hospital stay [（7.8 ＋ 2.4） days vs. （10.5 ±6.9） days, P=0.002]. Laparoscopic group and open group had similar morbidity of total complication [ 17.6% （13/74） vs. 28.4% （21/74）, P = 0.118]. Incidence of pneumonia was significantly lower in laparoscopic group [4.1%（3/74） vs. 13.5%（10/74）, P = 0.042）, while incidence of anastomotic leakage and stenosis, and complication grading were not significantly different between the two groups （all P 〉 0.05）. During a mean follow-up of 52.0 months, anal function analysis was performed in 102 patients with stoma closure and the result showed that the ratio of patients with good continence was 87.1%（54/62） and 87.5%（35/40） in laparoscopic and open group respectively （P = 0.066）. Conclusion Laparoscopie transabdominal ISR is safe and feasible, which is minimally invasive with fast recovery, and is worth clinical application