腹腔镜经腹会阴联合切除术与传统手术治疗低位直肠癌的近期随访比较

Comparative observation of short-term clinical outcome of laparoscopic and open transabdominal perineal resection for low rectal cancer

目的对比腹腔镜经腹会阴联合切除术与传统手术治疗低位直肠癌的近期随访效果及对肠道功能的影响。方法按照随机数表法将2014年12月至2018年12月期间就诊于本院的110例低位直肠癌患者分为两组,开腹组(55例)接受开腹手术治疗,联合组(55例)实施腹腔镜经腹会阴联合切除术治疗。通过SPSS 24.0软件进行分析,术后并发症及术后3个月复发率行χ^2检验;手术相关指标、肠道功能以(x±s)描述,采用独立样本t检验;P<0.05为差异有统计学意义。结果联合组术中出血量、切除标本长度低于开腹组(P<0.05);两组清扫淋巴结数目、手术时间差异无统计学意义(P>0.05);联合组会阴部引流管拔除时间、排气时间、术后住院时间均少于开腹组(P<0.05)。相比开腹组,联合组术后3个月MSKCC肠道功能问卷评分较高,并发症总发生率较低,差异均有统计学意义(P<0.05);联合组术后3个月复发率(1.8%)与开腹组(7.3%)相比,差异无统计学意义(P>0.05)。结论腹腔镜经腹会阴联合切除术与传统开腹手术均可有效治疗低位直肠癌,且近期复发率均较低,但前者具有操作精细、视野暴露充分、出血量低、并发症少等优势,利于保护肠道功能,安全可靠。

Objective To compare the short-term clinical outcome of laparoscopic and open transabdominal perineal resection for low rectal cancer. Methods 110 patients with low rectal cancer from December 2014 to December 2018 were divided into two groups by using random number table method, including 55 cases in the open group and 55 cases in the combined group. Statistical analysis were performed by using SPSS24.0 software. Measurement data such as surgical indicators and intestinal function were represented as (x±s) and were examined by using t test. Postoperative complications and 3-months recurrence rate were analyzed by using χ^2 test. A P value of <0.05 was considered as statistical significant difference. Results The amount of intraoperative bleeding and the length of resected specimens in the combined group were lower than those in the open group respectively(P<0.05). There was no significant difference between the two groups in terms of number of dissected lymph nodes and operation time(P>0.05). The removal time of perineal drainage tubes, exhaust time, and postoperative hospital stay in the combined group were less than those in the open group respectively(P<0.05). Compared with the open group, the MSKCC score of intestinal function questionnaire was higher and the total incidence of complications was lower in the combined group 3 months after operation(P<0.05);There was no significant difference of the recurrence rate between the combined group(1.8%) and the open group(7.3%)(P>0.05). Conclusion Laparoscopic transabdominal perineal resection and traditional open surgery could effectively treat low rectal cancer,and short-term recurrence rate is low,but the former has the advantages of refined operation,sufficient visual field exposure,less blood loss and complications,which is safe and reliable with protected intestinal function.