腹壁无切口手术治疗乙状结肠癌和高位直肠癌的临床疗效分析

Scarless surgery for the treatment of sigmoid and high-rectum carcinoma

目的通过对腹壁无切口手术与传统腹腔镜手术治疗乙状结肠癌和高位直肠癌近期疗效的比较，明确腹壁无切口手术的安全性、可行性及临床疗效。方法回顾性分析2014年1月至2017年3月在北京友谊医院就诊的100例诊断为乙状结肠癌和高位直肠癌的患者，其中45例患者行腹壁无切口手术，55例患者行传统的腹腔镜乙状结肠癌根治术或腹腔镜直肠癌根治术。结果腹壁无切口组在手术时间、手术失血量、术后镇痛药物次数的使用及肿瘤根治评价方面与传统腹腔镜组比较差异均无统计学意义[（143±66）min比（143±99）min、（54±31）ml比（73±90）ml、（1.1±1.0）次比（1.0±1.3）次，均P〉0．05]。腹壁无切口组术后疼痛评分较传统腹腔镜组低（2．0±1．0比2．6±1．0，t=2．9，P=0．005）。腹壁无切口组有1例肿瘤局部复发，1例腹腔多发转移，传统腹腔镜组有2例肝转移，1例死于肺炎。结论应用腹壁无切口手术治疗乙状结肠癌和高位直肠癌是安全、可行的。具有与传统腹腔镜手术相同的临床疗效。

Objective To evaluate the curative effect of trans-anal surgery vs. conventional laparoscopic surgery in treating sigmoid and high-rectum tumor. Methods From Jan 2014 to Mar 2017, 100 patients in Beijing Friendship Hospital participated in this clinical study. 45 patients underwent trans-anal surgery and 55 patients underwent conventional laparoscopic surgery. Results No significant difference was found between trans-anal surgery group and the traditional laparoscopic group in terms of operation time, blood loss, the use of analgesic drugs and the radical evaluation of tumor. While the postoperative pain scores in trans-anal surgery group （2. 0±1.0 vs.2.6±1.0, t=2.9, P=0.005 ） were lower than those in the conventional group. The follow-up data showed one case of local tumor recurrence and one case of multiple peritoneal metastasis in the trans-anal surgery group, compared to two cases of liver metastasis and one case dying of pneumonia in the conventional laparoscopic group. The remaining cases were of no local recurrence, nor distant metastases or any critical complications. Conclusions Trans-anal surgery in the treatment of sigmoid and high-rectum tumor is safe, reliable and having the same clinical efficacy with conventional laparoscopic surgery.