3种术式治疗低位直肠癌的疗效比较

Effects of three kinds of operation in treatment of low rectal cancer

目的比较3种术式治疗低位直肠癌的疗效。方法回顾性分析行手术治疗的低位直肠癌患者146例的临床资料,根据手术方式不同分为3组:38例行保留盆腔自主神经(PANP)的全直肠系膜切除术(TME)作为TME-PANP组,51例行直肠癌经腹前切除术(Dixon术)作为Dixon组,57例行经腹会阴联合直肠癌切除术(Miles术)作为Miles组,比较各组手术时间、住院时间,术前和术后1年发放生存质量评分量表(PAC-QOL)评估患者生存质量,术后1年评估患者排尿功能及男性患者性功能,并比较各组的3年生存率、局部复发率和远处转移率。结果 3组在手术时间和住院时间上比较(P<0.05),均有显著差异,TME-PANP组最短,其次为Dixon组,Miles组最长。术后1年,3组生活质量均显著下降(P<0.05),其中TME-PANP组PAC-QOL评分最低,其次为Dixon组,Miles组最高;TME-PANP组术后排尿功能、射精功能Ⅰ级的比例分别为71.05%、68.18%,明显高于Dixon组(43.14%、35.48%)和Miles组(22.81%、22.22%)(P<0.05),勃起功能Ⅰ级的比例为63.64%,高于Miles组(25.00%)(P<0.05),其余组间比较无差异(P>0.05);3组间术后3年生存率、局部复发率、远处转移率比较无显著差异(P>0.05)。结论 TME-PANP术可明显改善患者术后排尿功能和男性性功能,缩短术后恢复时间,值得临床推广。

Objective To compare the effects of three kinds of operation in the treatment of low rectal cancer. Methods The clinical data of 146 patients who had suffered from low rectal cancer and received surgical treatment were analyzed retrospectively and divided into three groups according to the operation methods： 38 patients who received total mesorectal excision（TME） with pelvic autonomic nerve plexus（PANP） reserved constituted a TME-PANP group, 51 patients who received transabdominal anterior resection of rectal cancer （Dixon） constituted a Dixon group, and 57 patients who received abdominoperineal resection of rectal cancer （Miles） constituted a Miles group. The operation time and length of stay （LOS） among the three groups were compared. Quality of life scales （PAC-QOL） were issued one year before and after operation to evaluate patients＇ quality of life. Patients＇ urinary function and sexual function in male patients were evaluated one year after operation. The three-year survival rate, local recurrence and distant metastasis rate among the three groups were compared. Results There were significant difference in the operation time and LOS among the three groups（P 〈 0.05）. The operation time and LOS in the TME-PANP group were the shortest, followed by those in the Dixon group, and those in the Miles group were the longest. One year after operation, the quality of life in the three groups decreased significantly （P 〈 0.05）. The PAC-QOL scores in the TME-PANP group were the lowest, followed by those in the Dixon group, and those in the Miles group were the highest; the ratios of Grade I post-operative urinary function and ejaculatory function in the TME-PANP group were 71.05% and 68.18% respectively, significantly higher than those in the Dixon group （43.14% and 35.48%） and in the Miles group （22.81% and 22.22%）（P 〈 0.05）; the ratio of Grade I erection function in the TME-PANP group was 63.64%, higher than that （25.00%） in the Miles group（P 〈 0.05）. There was no difference between the other two groups （P 〉 0.05）. The post-operative three-year survival rate, local recurrence rate and distant metastasis rate among the three groups showed no significant difference （P 〉 0.05）. Conclusion TME-PANP can significantly improve patients＂ post-operative urinary function and sexual function in male patients and shorten post-operative recovery time, and is worthy of clinical popularization.