自制平台腔镜下经肛辅助入路全直肠系膜切除术在中低位直肠癌患者中的应用效果

Application of self-made laparoscopic transanal assisted total mesorectal excision in patients with middle and low rectal cancer

目的观察自制操作平台腔镜下经肛辅助入路全直肠系膜切除术(TME)在中低位直肠癌患者中的应用效果。方法选取2016年6月~2018年6月百色市人民医院普外科收治的中低位直肠癌患者45例,按照随机数字表法将其分为两组,其中观察组20例,对照组25例。对照组患者行常规腹腔镜TME,观察组使用自制平台腔镜下经肛入路与经腹结合TME。比较两组手术相关指标及手术切除直肠标本病理学情况;比较两组治疗相关费用;随访统计并比较两组术后并发症、复发和死亡情况。结果两组手术时间、手术切除直肠长度、肿瘤远端切缘长度、淋巴结清扫数目、直肠系膜完整度及切缘阴性率比较,差异无统计学意义(P > 0.05);观察组术中失血量少于对照组,并发症发生率低于对照组,肛门排气时间、住院时间均短于对照组,差异均有统计学意义(P < 0.05);观察组手术费用、住院费用显著低于对照组,差异有统计学意义(P < 0.05);两组术后各失访2例,随访时间3个月~2年,且随访期间两组无复发和死亡情况发生。结论自制平台腔镜下经肛辅助入路TME治疗中低位直肠癌与腹腔镜TME比较,手术时间、手术切除直肠情况相当,但前者具有术中失血量小、术后恢复快、费用低、并发症少等多种优点,值得推广。

Objective To observe the effect of percutaneous transanal assisted total mesorectal excision (TME) in patients with moderate-low rectal cancer. Methods From June 2016 to June 2018, 45 cases of moderate-low rectal cancer patients admitted to the General Surgery People′s Hospital of Baise were selected and divided into two groups by the random number table method. There were 20 patients in the observation group and 25 patients in the control group. The control group was treated with conventional laparoscopic TME, and the observation group was treated with self-made platform laparoscopic transanal approach and transabdominal TME. The surgically related indicators and rectal surgical specimens were compared in the two groups. Treatment-related costs of the two groups were compared. Follow-up statistics and comparison of postoperative complications, recurrences, and deaths were compared and compared in the two groups. Results There was no significant difference in operation time, length of rectum resection, length of distal tumor resection margin, number of lymph node dissection, mesenteric integrity and negative rate of resection margin between the two groups (P > 0.05). Intraoperative blood loss in the observation group was less than that in the control group, the incidence of complications was lower than that in the control group, and the time of anal exhaust and hospital stay were shorter than that in the control group, with statistically significant differences (P < 0.05). The costs of operation and hospitalization in the observation group were significantly lower than those in the control group, with statistically significant differences (P < 0.05). Two cases were lost to follow-up in the two groups, and the follow-up period was 3 months to 2 years. No recurrence or death occurred in the two groups during the follow-up period. Conclusion Compared with laparoscopic TME in the treatment of middle and low rectal cancer under self-made platform endoscopy, TME through anal assisted approach has similar operation time and surgical resection of rectum, but the former has many advantages, such as small intraoperative blood loss, fast postoperative recovery, low cost and few complications, and is worthy of promotion.