腹腔镜经腹经肛管内外括约肌间切除术与传统开腹术式在超低位直肠癌保肛治疗中的比较研究

Comparative study of laparoscopic and open ISR

目的比较研究腹腔镜经腹经肛管内外括约肌间切除术(ISR)与传统开腹ISR在超低位直肠癌保肛治疗中的作用。方法选取2013年1月至2015年8月在我院接受治疗的90例直肠癌保肛手术患者,根据入组条件将患者分为观察组和对照组,观察组患者45例行腹腔镜经腹ISR手术,对照组患者45例行传统开腹ISR手术,比较两组患者的手术时间、术中出血量、正常饮食时间、肛门排气时间、并发症以及住院时间、淋巴结清扫数目、远切缘长度、环周切缘阳性率以及局部复发率、死亡率以及肛门功能等。结果观察组患者的手术时间、排气时间、正常饮食时间、术后住院时间(185.3±15.9 min、2.6±0.2 d、6.2±1.1 d、7.6±1.2 d)都明显的短于对照组(223.0±21.4 min、3.3±0.4 d、7.6±1.0 d、9.68±0.6 d),术中出血量以及术后并发症的发生(157.3±12.5 m L、4.44%)明显的低于对照组(214.6±30.2 m L、20.00%),差异有统计学意义(P<0.05);观察组患者的淋巴结清扫数目、远切缘长度与对照组进行比较差异无统计学意义(P>0.05);观察组患者的环周切缘阳性率、局部复发率、远处转移率以及死亡率(4.44%、2.22%、0.00%、2.22%)都明显的低于对照组(20.00%、15.56%、11.11%、22.22%),差异有统计学意义(P<0.05);观察组患者排便紧迫感、排便频率以及排便困难都低于对照组患者,Wexner评分高于对照组,比较无统计学意义(P>0.05)。结论腹腔镜经腹ISR在超低位直肠癌保肛手术中具有比较好的临床疗效和安全性。

Objective To support the clinical dada in comparison between laparoscopic and traditional open abdominal intersphincteric resection(ISR). Methods In this retrospective case-controlled study,90 colorectal cancer cases with anal sphincter preservation surgery were recruited from January2013 to August 2015 in our hospital for treatment,in which 45 cases received open ISR(control group),and other 45 cases underwent laparoscopic transabdominal ISR(observation group). The operative time,blood loss,regular mealtimes,flatus,complications,and length of stay,number of lymph node dissection,far margin length,positive circumferential resection margin and local recurrence rate,mortality and anal functions between the two groups were compared. Results The operation time,flatus time,normal diet time,postoperative hospital stay(185.26±15.89 min,2.61±0.21 d,6.15±1.14 d,7.59 ± 1.15 d) in the observation group were significantly shorter than those in the control group(223.02 ± 21.35 min,3.26±0.411 d,7.58±0.98 d,9.58±0.64 d)(all P values <0.05). Blood loss and the postoperative complications were significantly lower in the observation group(157.26 ± 12.54 m L,4.44%)than in the control group(214.58±30.15 m L,20.00%),(P<0.05 for all). No difference of the number of lymph node dissection and far margin length were found between the two groups(P>0.05).The circumferential positive margin rate,the rate of local recurrence,distant metastasis and mortality were significantly lower in the observation group(4.44%,2.22%,0.00%,2.22%)than that in the control group(20.00%,15.56%,11.11%,22.22%),(P<0.05 for all);The defecation urgency,stool frequency and bowel problems were lower significantly in the observation group than in the control group patients(P<0.05).No significant difference of Wexner were found between the two groups(P>0.05).Conclusion Laparoscopic abdominal ISR surgery in ultralow colorectal cancer has better clinical efficacy and safety.