经肛移除标本的腹腔镜直肠癌根治术39例回顾性分析

Retrospective analysis of 39 rectal cancer patients of laparoscopic rectal radical resection with transanal specimen extraction

目的探讨免切口经肛移除标本的腹腔镜直肠癌根治术的适用性、安全性和短期疗效。方法回顾性分析2016年8月至2018年7月在山东省立医院胃肠外科行腹腔镜直肠癌根治术的879例病人的临床资料,根据肿瘤最大径、T分期、体质量指数等纳入排除标准筛选病例。根据移除标本方式的不同分为两组,免切口经肛移除标本的病人作为观察组(经肛免切口组),经腹小切口移除标本的病人作为对照组(常规腹腔镜组),分析其临床病理资料、围手术期指标及术后并发症。结果经肛免切口组39例病人,常规腹腔镜组77例病人。两组病人的性别、年龄和T分期差异无统计学意义(P>0.05),但两组病人的体质量指数、肿瘤最大径、肿瘤下缘与齿状线距离差异有统计学意义(P<0.05);两组病人的手术时间、淋巴结清除数目和住院费用等差异无统计学意义(P>0.05),经肛免切口组病人的术中出血、术后疼痛评分、术后C反应蛋白水平、排气时间和住院天数等均优于常规腹腔镜组(P<0.05);两组病人的术后短期并发症差异无统计学意义(P>0.05)。结论免切口经肛移除标本的腹腔镜直肠癌根治术适用肿瘤较小、非重度肥胖的中高位直肠癌病人;与常规腹腔镜直肠癌根治术相比,其手术安全,创伤更小,术后病人恢复更快,不增加术后短期并发症风险。

Objective To investigate the applicability, safety and short-term efficacy of laparoscopic radical resection of rectal cancer with transanal specimen extraction. Methods 879 patients who underwent laparoscopic total mesorectal excision with rectal cancer from August 2016 to July 2018 in the Department of Gastrointestinal Surgery of Shandong Provincial Hospital were selected and analyzed according inclusion and exclusion criteria. Patients were divided into two groups according to the different ways of specimen removal. The patients who underwent transanal incision as the study group and the patients who underwent conventional laparoscopy as the control group. The clinicopathological data, perioperative indicators and postoperative complications were analyzed. Results There were 39 patients enrolled in Transanal incision group, and 77 patients in the Conventional laparoscopic group. There was no difference in gender, age and T stage between the two groups( P >0.05), while there was difference in the distance of body mass index, tumor maximum diameter and the distance of tumor from the dentate line( P <0.05). There was no statistical difference in the operation time, number of lymph nodes harvested, postoperative complications and hospitalization costs ( P >0.05). Blood loss, postoperative pain scores, C-reactive protein level, gastrointestinal function recovery time and length of hospital stay in Transanal incision group were better than those in the conventional laparoscopic group ( P <0.05). Conclusion Transanal specimen extraction for laparoscopic total mesorectal excision is suitable for middle-high rectal cancer patients with small tumors and non-severe obesity. It is safe and effective with less trauma and faster recovery than conventional laparoscopic total mesorectal excision. In addition, it doesn't increase the risk of short-term postoperative complications.