腹腔镜辅助联合肛门内括约肌加强治疗直肠癌的价值探讨

The value of laparoscopic-assisted combined with anal sphincter strengthening in the treatment of low rectal cancer

目的探讨腹腔镜辅助联合肛门内括约肌加强治疗直肠癌的可行性及临床价值。方法选择2014年1月—2018年4月收治的直肠癌患者65例作为观察对象。将这组患者分为对照组和观察组,前期32例传统开放手术为对照组,后期33例在腹腔镜辅助下治疗设为观察组,同时,全组应用自行设计的折叠结肠浆肌层加强肛门内括约肌的方法进行原位肛门成形术。手术后对比两组患者的临床指标及并发症发生率,同时手术前及术后1个月、3个月、6个月、12个月测定肛管压力,评价肛门功能及临床效果。结果观察组患者恢复胃肠功能时间、留置导尿管时间、住院时间、并发症发生率均低于对照组(P<0.05);术后随访1个月、3个月、6个月时肛管压力较术前降低,而随访12个月时基本恢复术前压力水平。结论在直肠癌保肛手术中应用腹腔镜辅助治疗可获得良好的手术野和理想的临床效果,降低并发症发生率及住院时间,利于术后胃肠功能恢复。且肛门内括约肌加强有利于恢复术后肛管压力,有效控制排便,避免肠造瘘,值得临床推广。

Objective:To investigate the feasibility and clinical value of laparoscopic-assisted combined with anal sphincter strengthening in the treatment of rectal cancer.Methods:65 patients with rectal cancer admitted from January 2014 to April 2018 were selected as the observation objects.This group of patients was divided into the control group and the observation group.In the early stage,32 patients were treated with traditional open surgery,and in the later stage,33 patients were all treated with laparoscopy.After the operation,the clinical indicators and complication rates of the two groups were compared,and the anal pressure was measured at 1m,3m,6m and 12m before and after the operation,to evaluate the anal function and clinical effect.Results:The recovery time of gastrointestinal function,indwelling catheter,hospitalization time and complication rate in the observation group were all lower than those in the control group(P<0.05).Postoperative follow up of 1m,3m and 6m showed that the anal pressure was lower than that before the operation,while the preoperative pressure was restored after the follow up of 12m.Conclusion:The application of laparoscopic adjuvant therapy in rectal cancer anal preservation surgery can achieve good surgical field and ideal clinical effect,reduce the incidence of complications and hospital stay,and facilitate postoperative recovery of gastrointestinal function.In addition,strengthening the anal sphincter is conducive to restoring postoperative anal pressure,effectively controlling defecation and avoiding intestinal fistula,which is worthy of clinical promotion.