腹腔镜ISR治疗低位直肠癌的肿瘤学疗效及肛门功能观察

Laparoscopic ISR in the treatment of low rectal cancer:oncological efficacy and anal function

目的探讨腹腔镜内外括约肌间切除术(ISR)治疗低位直肠癌的肿瘤学疗效及对肛门功能的影响。方法回顾性分析北京市丰台中西医结合医院78例低位直肠癌患者的临床资料,其中行腹腔镜ISR(观察组)42例,开腹ISR(对照组)36例。对比两组手术相关指标、肿瘤学疗效、肛门功能分级、术后并发症发生率及术后生存率。结果两组手术时间比较差异无显著统计学意义(t=1.208,P>0.05)。观察组术中出血量显著低于对照组,通气时间、禁食时间、住院时间显著短于对照组(均P<0.05)。两组淋巴结检出数目、肿瘤大小、肿瘤下缘距远端切缘长度、组织分化程度、TNM分期比较差异无统计学意义(均P>0.05)。两组Wexner评分、排便频率、排便紧迫感、控粪能力降低、Kirwan肛门功能分级比较无统计学意义(均P>0.05)。观察组术后并发症发生率显著低于对照组(χ2=5.520,P<0.05)。两组术后3年生存率比较差异无统计学意义(χ2=1.065,P>0.05)。结论腹腔镜ISR与开腹ISR治疗低位直肠癌在肿瘤学疗效、术后生存率及对肛门功能影响方面的效果相当,但前者手术创伤更小,可降低术中出血量,促进患者康复,减少并发症的发生,更具临床应用价值。

Objective To investigate the efficacy of laparoscopic internal and external resection of the sphincter(ISR)in the treatment of low rectal cancer and its influence on anal function.Methods Seventy-eight patients with low rectal cancer in Beijing Fengtai Integrated Traditional Chinese Medicine and Western Medicine Hospital were retrospectively analyzed,including forty-two cases of laparoscopic ISR(observation group)and thirty-six cases of open ISR(control group).The operation related indexes,oncological efficacy,anal function classification,postoperative complication rate and postoperative survival rate were compared between the two groups.Results There was no significant difference in the operation time between the two groups(t=1.208,P>0.05).The intraoperative blood loss in the observation group was significantly lower than that in the control group,and the ventilation time,fasting time and length of stay were significantly shorter than those in the control group(P<0.05).The number of lymph nodes detected,the size of tumor,the length of distal margin of tumor,the degree of tissue differentiation and TNM staging were not significantly different between the two groups(P>0.05).Two Wexner score,frequency of defecation,urgency of defecation,bowel control reduce,Kirwan anal function grading were not statistically significant between the two groups(P>0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group(χ2=5.520,P<0.05).There was no significant difference in the 3 year survival rate between the two groups(χ2=1.065,P>0.05).Conclusions The effect of laparoscopic ISR and open ISR on the efficacy of oncology,survival rate and anorectal function in patients with low rectal cancer is comparable,but the former is less traumatic,reduces intraoperative bleeding,promotes rehabilitation,reduces complications,and has more clinical application value.