经肛门联合腹腔镜根治性全直肠系膜切除术治疗直肠癌的可行性和安全性

Feasibility and safety of transanal and laparoscopic total mesorectal excision for rectal cancer

目的:探讨经肛门联合腹腔镜根治性全直肠系膜切除术治疗直肠癌的可行性和安全性。方法:选取2016年1月至2017年12月在广东省梅州市人民医院行根治性全直肠系膜切除术治疗的直肠癌患者60例为研究对象,按信封法随机分为研究组(n=30)和对照组(n=30)。对照组常规行腹腔镜根治性全直肠系膜切除术治疗,研究组行经肛门联合腹腔镜根治性全直肠系膜切除术治疗。比较两组手术情况、淋巴结清扫枚数、病理标本下切缘的距离以及并发症发生率等。结果:两组手术时间、术后下床时间、留置尿管时间、术后1 d视觉模拟评分(VAS)、淋巴结清扫枚数、病理标本下切缘距离均无明显差异(均P>0.05)。与对照组比较,研究组术中出血量增加,术后胃肠道功能恢复时间及术后住院时间缩短(均P<0.05)。两组术后切口感染和肺部感染等并发症发生率比较,差异无统计学意义(P>0.05)。结论:直肠癌经肛门联合腹腔镜根治性全直肠系膜切除术治疗可行性和安全性良好,值得临床推广。

Objective: To investigate the feasibility and safety of transanal and laparoscopic total mesorectal excision for rectal cancer. Methods: 60 patients with rectal cancer treated by radical mesorectal excision in the hospital from January 2016 to December 2017 were selected,and randomly divided into a study group( n =30) and a control group( n =30).The patients in the control group were treated with laparoscopic radical total mesorectal excision,and those in the study group underwent laparoscopic total mesorectal excision with laparoscopy.The operation condition,number of lymph node dissection,the distance of the cut edge of pathological specimen,and complications incidence were compared. Results: There were no significant differences in operation time,postoperative time of detaining the bed,the time of indwelling catheter,VAS score on day 1 post-operation,the number of lymph node dissection,and the distance between the cutting edge of the pathological specimen between the two groups( P >0.05).Compared with the control group,the blood loss volume was increased while the recovery time of gastrointestinal function and hospital days were decreased in the study group( P <0.05).There was no significant difference in the incidence of complications such as incision infection and pulmonary infection between the two groups( P >0.05). Conclusion: Transanal and laparoscopic total mesorectal excision in the treatment of rectal cancer is feasible and safe.