腹腔镜经括约肌间切除术与腹腔镜Dixon术治疗超低位直肠癌的临床疗效对比研究

Comparing laparoscopic intersphincteric resection and laparoscopic Dixon surgery in the treatment of ultra-low colon cancer

目的比较腹腔镜经括约肌间切除术(LapISR)与腹腔镜Dixon术治疗超低位直肠癌的临床效果。方法纳入2012年7月至2016年7月本院90例超低位直肠癌患者作为研究对象,随机抽签分为两组,每组各45例。观察组行LapISR,对照组行常规腹腔镜Dixon术。比较两组围术期指标、术后并发症发生情况、肛门功能及术后1年总生存情况。结果两组均无术中中转开腹病例。两组患者手术时间、淋巴结清扫数目、环周切缘阳性率及住院时间差异均无统计学意义(均P> 0.05),观察组术中出血量少于对照组(P<0.05),术后首次肛门排气时间短于对照组(P<0.05)。两组并发症总发生率差异无统计学意义(P> 0.05)。两组术后1年总生存率差异无统计学意义(P> 0.05)。两组术后半年和1年时Wexner·评分均低于组内出院时,观察组出院时和术后半年时Wexner评分低于对照组,差异均有统计学意义(均P<0.05)。结论 LapISR与常规腹腔镜治疗超低位直肠癌术后1年总生存率相当,前者更有助于术后肛门功能早期恢复。

Objective To compare the effect of laparoscopic intersphincteric resection （LapISR） and laparoscopic Dixon operation in the treatment of ultra-low colon cancer. Methods 90 patients with ultra-low colon cancer who were treated in our hospital from Jul 2012 to Jul 2016 were recruited as research subjects and were randomly assigned to two group, with 45 patients in each group. Patients in the treatment group received LapISR and patients in the control group received routine laparaoscopic Dixon operation. Indices related to perioperative period, as well as postoperative complications, anal function and overall survival at 1 year were compared between the two groups. Results There was no conversion to open surgery in either group. There was no significant difference between the two groups in duration of operation, number of dissected lymph nodes, positive rate at the resection margin, and duration of hospitalization （P 〈 0.05）. Blood loss was fewer in the treatment group than in the control group （P 〈 0.05）. Time to postoperative anal exhaust was shorter in the treatment group than in the control group（P 〈 0.05）. There was no significant difference between the two groups in overall incidence of postoperative complications （P 〉 0.05）. There was also no significant difference between the two groups in overall survival at 1 year （P 〉 0.05）. In both groups, Wexner scores at 6 months and 1 year were lower than at discharge. Wexner scores at discharge and 6 months were significantly lower in the treatment group than in the control group （P 〈 0.05）. Conclusion Survival was similar between LapISR and routine laparoscopic surgery in treating ultra-low colon cancer but LapISR is more beneficial for postoperative anal function recovery.