手术方式对肛缘距离≤8.0 cm中老年T1期直肠癌患者治疗效果和安全性的影响

Influence of surgical approach on therapeutic effect and safety for middle-aged and elderly patients with DAV ≤8.0 cm rectal cancer of T1 stage

目的探讨不同手术方式对肛缘距离(DAV)≤8.0 cm中老年T1期直肠癌患者治疗效果和安全性的影响。方法回顾性分析2012年1月至2014年1月76例距肛缘距离(DAV)≤8.0 cm中老年直肠癌T1期患者的资料,根据不同手术方式分为局部切除组(39例,行经肛门局部切除术)和根治切除组(37例,行经腹根治性切除术)。采用SPSS 22.0统计软件进行分析,术中术后相关指标以(x±s)表示,采用独立t检验;术后并发症发生率及死亡率组间对比采用χ2检验。P<0.05为差异有统计学意义。结果与根治切除组比,局部切除组患者手术时间、术中出血量显著减少,术后首次排气时间、首次进食时间、留置导尿管时间、住院时间和术后并发症发生率显著降低,尤其是肺部感染发生率;术后3年内肛门失禁、性功能障碍发生率显著降低,差异均具有统计学意义(P<0.05)。两组患者3年内肿瘤复发、转移发生率及生存率相比,差异均无统计学意义。结论经肛门局部切除术与经腹根治性切除术治疗DAV≤8.0 cm中老年T1期直肠癌患者的临床效果及3年预后相近,但前者术后并发症发生率显著低于后者,且在排便功能及性功能保护方面显著优于后者。

Objective To explore the influence of surgical approach on therapeutic effect and safety for middle-aged and elderly patients with distance from anal verge （DAV） ≤8.0 cm rectal cancer of T1 stage. Methods The clinical data of 76 cases with distance from anal verge （DAV） ≤8.0 cm rectal cancer of T1 stage treated in our hospital from January 2012 to January 2014 were collected and retrospectively analyzed. According to different surgical approaches, the patients were divided into the transanal excision group （39 cases, undergoing transanal local resection） and the radical excision group （37 cases , undergoing radical resection）. All data were analyzed by SPSS 20.0 statistical software. The intraoperative and postoperative related indicators were presented as （ x±s） and were compared by t test. The incidence of postoperative complications and death were presented as [n （%）]] and were compared by chi square. Results All patients of two groups were successfully completed the surgery. Compared with the radical excision group, the operation time in the transanal excision group was significantly shortened, the intraoperative blood loss in the transanal excision group was significantly decreased, the postoperative first feeding time, first exhaust time, drainage time, length of stay in the transanal excision group were significantly shortened, the rate of totally postoperative complications, especially lung infection, in the transanal excision group were significantly decreased, and the anus incontinence and sexual dysfunction incidence within 3 years after operation in the transanal excision group were significantly decreased （P 〈0.05） . There was no statistical difference in the rate of mortality, recurrence rate and metastasis between two groups （P 〉0.05）. Conclusion The transanal local resection in treatment for middle-aged and elderly patients with DAV ≤8.0 cm rectal cancer of T1 stage is consistent with the radical excision in therapeutic effect and prognosis, and the protection of defecation and sexual functions in transanal local resection is superior to those in radical excision.