腹腔镜下直肠低位前切除术与直肠经肛门拖出切除术治疗直肠癌的效果比较

Comparison of the effect between laparoscopic rectal low anterior resection and transanal pull through surgery for low rectal cancer

目的比较直肠癌患者经腹腔镜下直肠低位前切除术与直肠经肛门拖出切除术后的治疗效果。方法选取2014年7月至2016年12月进行腹腔镜下直肠低位前切除术与直肠经肛门拖出切除术的不同手术方式患者共120例,按照不同手术方式分为镜下组和拖出组两组,每组各60例,镜下组行腹腔镜下直肠低位前切除术,拖出组行直肠经肛门拖出切除术。采用SPSS 18.0软件对所有数据进行统计分析,术中术后指标以均数±标准差表示,组间比较采用t检验;术后并发症发生率采用χ2检验;P<0.05差异有统计学意义。结果术中出血量、住院时间相比,直肠经肛门拖出切除术患者少于腹腔镜下直肠低位前切除术,P<0.05。术后肠功能恢复情况如术后1、3、6个月患者排便次数相比,拖出手术组明显恢复情况好于镜下组,P<0.05,差异具有明显统计学意义;术后并发症相比,中青年患者拖出手术组术后并发症发生率为6.7%(2/30),镜下手术组为30%(9/30),老年患者拖出手术组术后并发症发生率为6.7%(2/30),镜下手术组为26.7%(8/30),不同年龄段患者内部比较,P<0.05,差异具有明显统计学意义。结论直肠经肛门拖出切除术的手术疗效和术后患者恢复情况均好于腹腔镜下直肠低位前切除术,治疗效果满意,手术操作安全,具有临床推广意义。

Objective To compared the curative effect between laparoseopic rectal low anterior resection and transanal pull through surgery for low rectal cancer. Methods 120 patients with low rectal cancer of our hospital from July 2014 to October 2016 were selected and divide into laparoscopic group and transanal pull group by different surgical methods, with 60 cases in each group. The patients in laparoscopic group were treated by laparoscopic rectal low anterior resection, while the patients in transanal pull group were treated by transanal pull through surgery. Statistical analysis was perfmned by using SPSS 18. 0 software, all the observation target were presented as and examined by using t test; enumeration data was examined by chi square test. A P value of 〈 0.05 was considered as significant difference. Results Intraoperative blood loss and hospitalization days in transanal pull group were less than those in laparoscopic group, with significant difference （P 〈 0.05 ） ; The post-operative bowel function such as defecation times in 1, 3, 6 months in transanal pull group were more better than those in laparoscopic group, with significant difference （ P 〈 0.05 ） ; The post-operative complications of the young and middle-aged patients in transanal pull group was 6. 7% （2/30）, which in laparoscopic group was 30% （9/30） ; the post-operative complications of elderly patients in transanal pull group was 6.7% （2/30）, which in laparoscopic group was 26.7% （ 8/30）, the comparison of different aged patients showed significant difference （ P 〈 0. 05 ）. Conclusion The operation effect and post-operative recovery of patients with transanal pull through surgery are better than patients with laparoscopic rectal low anterior resection. Transanal pull through surgeD＇ has satisfactory therapeutic effectand the operation is safe and reliable, which is worthy of popularizing in clinic.