两种保留自主神经D3根治术治疗中低位直肠癌的安全性及生存质量比较

Comparison of the safety and quality of life of two kinds of D3 radical resection for middle and low rectal cancer with autonomic nerve preservation

目的比较腹腔镜保留自主神经D3根治术与开腹术治疗中低位直肠癌的安全性及生存质量差异。方法回顾性分析2015年6月至2017年8月间84例低位直肠癌患者资料,根据手术方式不同分为腹腔镜组(n=46)和开腹组(n=38),应用SPSS21.0软件完成数据分析。手术相关指标采用(x^-±s)表示,独立样本t检验;并发症发生率、复发率及生存率等指标采用χ^2检验;P<0.05为差异有统计学意义。结果腹腔镜组患者的手术时间长于开腹组(P<0.05),而术中出血量、住院时间、尿管保留时间、肛门排气时间均短于开腹组(均P<0.05)。腹腔镜组术后并发症总发生率为6.5%低于开腹组的26.3%(χ^2=4.6517,P<0.05)。两组患者1年局部复发率及生存率差异均无统计学意义(均P>0.05)。腹腔镜组患者术后10 d排尿功能、术后2个月勃起功能、术后2个月射精功能均优于开腹组(均P<0.05)。结论腹腔镜保留自主神经D3根治术治疗中低位直肠癌安全性较高,复发率及生存率与开腹术相当,并能显著提高患者的生存质量,值得推广应用。

Objective To compare the safety and quality of life of laparoscopic and open D3 radical resection for middle and lower rectal cancer with autonomic nerve preservation. Methods The clinical data of 84 patients with middle and lower rectal cancer treated in our hospital from June 2015 to August 2017 were retrospectively selected. According to the different surgical methods, the patients were divided into laparoscopic group(n=46) and open group(n=38) respectively. Data analysis was performed by statistical software SPSS21.0. The surgery related indicators of the two groups was compared by two independent samples t-test. The complication rate, recurrence rate, index of quality of life of the two groups were compared by χ^2 test, P<0.05 was considered statistically significant. Results The operation time in the laparoscopic group was longer than that in the open group(P<0.05), the intraoperative blood loss, hospitalization time, urinary catheter retention time, and anal exhaust time were shorter than those in the open group(P<0.05). The total incidence of postoperative complications in the laparoscopic group was 6.5%, which was lower than 26.3% in the open group, the difference was statistically significant(χ^2=4.6517, P<0.05). There was no significant difference in the 1-year local recurrence rate, and 1-year survival rate between the two groups(P>0.05). In the laparoscopic group, the urinary function at 10 days after operation, the erectile function at 2 months after operation, and the ejaculation function at 2 months after operation were better than those in the open group(all P<0.05). Conclusion The surgical effect of laparoscopic D3 radical resection for middle and lower rectal cancer with autonomic nerve preservation is significant, the safety is higher, the recurrence rate and survival rate are comparable to open surgery, and it can significantly improve the quality of life of patients, which is worthy of clinical promotion and application.