腹腔镜辅助经肛门全直肠系膜切除术与全直肠系膜切除术的临床对比研究

A comparative study of laparoscopic transanal total mesorectal resection (TaTME) and total mesorectal resection (TME)

目的对比腹腔镜辅助经肛门全直肠系膜切除术(TaTME)与全直肠系膜切除术(TME)在低位直肠癌中的临床疗效。方法回顾性分析2014年5月至2016年11月接受TME的83例低位直肠癌患者资料,其中TaTME组41例,TME组42例;采用SPSS 21.0统计学软件进行分析,胃肠指标、肛门功能评分等采用(x±s)表示,独立t检验;并发症等计数资料行χ2或秩和检验;采用Kaplan-Meier法进行生存分析,行log-rank检验;P<0.05为检验水准。结果TaTME组手术时间、出血量多于TME组,术后恢复指标优于TME组(P<0.05)。TaTME组并发症总发生率7.3%小于TME组19.0%(P<0.05)。术后1个月,两组血清胃动素、胃泌素水平均不同程度降低,TaTME组优于TME组(P<0.05)。术后6个月,TaTME组肛门失禁Wexner评分明显低于TME组(P<0.05);术后12个月时两组评分无差异(P>0.05)。术后6个月时两组肛门功能Kirwan分级比较,TaTME组肛门功能良好率优于TME组(P<0.05)。Kaplan-Meier法生存分析发现,术后2年两组局部复发率、远处转移率及生存率差异无统计学意义(P>0.05)。结论腹腔镜辅助TaTME治疗低位直肠癌术中安全、可行,其整体疗效优于TME,可在临床治疗中推广使用.

Objective To observe clinical outcome of laparoscopic trans-anal total mesorectal resection(TaTME)and total mesorectal resection(TME)in patients with low rectal cancer.Methods From May 2014 to November 2016,clinical data of 83 patients with low rectal cancer who received TME were retrospectively analyzed,including 41 patients in TaTME group and 42 patients in TME group.Statistical analysis were performed by using SPSS 21.0 software.Measurement data,such as gastrointestinal indexes and anal function score were expressed as(x±s),and were examined by independent test.Count data such as postoperative complications were examined by chi square test.Kaplan-meier method was used for survival analysis and log-rank test was performed.A P value<0.05 was considered as statistically significant difference.Results The operation time and blood loss in TaTME group were more than those in TME group,and the postoperative recovery indexes were better than those in TME group respectively(P<0.05).The total incidence of complications was 7.3%in TaTME group and 19.0%in TME group(P<0.05).One month after the operation,serum motilin and gastrin levels in the two groups decreased to different degrees,and TaTME group was superior to TME group(P<0.05).6 months after surgery,Wexner score of patients in TaTME group was significantly lower than that of TME group(P<0.05).At 12 months after surgery,there was no difference in scores between the two groups(P>0.05).Six months after surgery,Comparison of Kirwan grading of anal function between the two groups showed that the rate of good anal function in TaTME group was better than that in TME group(P<0.05).Kaplan-meier survival analysis found no significant difference in local recurrence rate,distant metastasis rate and survival rate between the two groups on 2 years after surgery(P>0.05).Conclusion Laparoscopic TaTME in the treatment of low rectal cancer is safe and feasible,and its overall efficacy is better than that of TME,which could be widely used in clinical application.