不同手术方案对Ⅱ～Ⅲ期超低位直肠癌患者疗效及安全性的影响

Influence of different operation scheme on clinical effects and safety of patients with ultralow rectal cancer

目的探讨Miles手术、腹腔镜下双吻合器及腹腔镜拉下式前切除术对Ⅱ～Ⅲ期超低位直肠癌患者疗效及安全性的影响。方法选取该院2014年6月-2017年6月收治的Ⅱ～Ⅲ期超低位直肠癌共210例,根据手术方案不同分为A组(70例)、B组(70例)及C组(70例),分别行Miles手术、腹腔镜下双吻合器及腹腔镜拉下式前切除术治疗;比较3组手术相关临床指标水平、随访肛门功能优良率、便意感复常率及术后并发症发生率。结果 B和C组术中出血量、术中淋巴结清扫数目及住院时间均明显优于A组(P <0.05);B和C组手术操作时间明显长于A组(P <0.05);C组随访3和6个月,肛门功能优良率均明显高于B组(P <0.05);C组随访3和6个月,便意感复常率均明显高于B组(P <0.05);B和C组术后并发症发生率均明显低于A组(P <0.05);B和C组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论腹腔镜前切除术治疗Ⅱ～Ⅲ期超低位直肠癌患者较Miles手术在降低手术创伤程度和加快康复进程方面具有优势,但可能增加操作时间;且相较于双吻合器前切除术,腹腔镜拉下式前切除术治疗Ⅱ～Ⅲ期超低位直肠癌,能够明显保护肛门功能,改善日常生活质量,且安全性值得认可。

Objective To investigate the influence of Miles operation, minimally invasive double stapler and pull down for anterior resection on clinical effects and safety of patients with ultralow rectal cancer. Methods 210 patients with ultralow rectal cancer were chosen from June 2014 to June 2017 and divided according to operation scheme into 3 groups including A group (70 patients) with Miles operation, B group (70 patients) with double stapler for anterior resection and C group (70 patients) with pull down for anterior resection;and the operation-related clinical index, good and excellent rate of anal function with follow-up, meaning sense normal rate with follow-up and postoperative complications incidence of 3 groups were compared. Results The intraoperative blood loss volume, intraoperative lymph node dissection number and hospital stay of B group and C group were significant better than that in A group (P < 0.05). The operation time of B group and C group were significant longer than that in A group (P < 0.05). The good and excellent rate of anal function in 3 months and 6 months after operation of C group were significant higher than that in B group (P < 0.05). The meaning sense normal rate in 3 months and 6 months after operation of C group were significant higher than that in B group (P < 0.05). There was no significant difference in the postoperative complications incidence among the 3 groups (P > 0.05). Conclusion Minimally invasive anterior resection in treatment of patients with ultralow rectal cancer possess advantages in reducing surgical trauma degree and speeding up rehabilitation process and may increase the operation time;compared with minimally invasive double stapler, minimally invasive pull down for anterior resection in the treatment of patients with ultralow rectal cancer can efficiently protect anal function, improve the quality of daily life and the safety is worth recognition.