直肠癌经肛门与腹腔镜全直肠系膜切除术治疗的可行性和安全性比较

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

目的比较直肠癌经肛门联合腹腔镜根治性全直肠系膜切除术治疗的可行性和安全性。方法选取2016年1月至2019年1月拟我院行根治性全直肠系膜切除术治疗的直肠癌患者100例为研究对象,信封法随机分为研究组(n=50)和对照组(n=50)。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、治疗前后血清白介素(IL-6)、IL-8等炎症细胞因子水平、治疗有效率、肿瘤相关死亡率、局部复发率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1d VAS疼痛评分、淋巴结清扫枚数、病理标本下切缘的距离等均无明显差异(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缩短以及术后住院时间缩短,治疗后血清IL-6、IL-8等炎症细胞因子水平降低,治疗有效率提高,肿瘤相关死亡率、局部复发率降低(P<0.05)。两组术后切口感染、肺部感染、吻合口瘘等并发症发生率未见明显差异(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 compare the feasibility and safety between transanal and laparoscopic total mesorectal excision of rectal cancer.Methods A total of 100 rectal cancer patients who underwent elective surgery of radical mesorectal excision in our hospital between January 2016 and January 2019 were enrolled.Envelope method was used to randomized the subjects into study group(n=50)and control group(n=50).The control group underwent conventional laparoscopic radical mesorectal excision,and the study group underwent combined transanal and laparoscopic radical mesorectal excision.The operation,number of dissected lymph nodes,distance of the lower cutting margin from the anus,serum levels of interleukin(IL-6),IL-8 and other inflammatory cytokines before and after treatment,treatment efficiency,tumor-related mortality,local recurrence and complications were compared between groups.Results There were no significant differences between the two groups in the operation time,postoperative time to out-of-bed activity,duration of catheter indwelling,1-day VAS pain score,lymph nodes dissected,and distance of cutting margins to anus(P>0.05).Compared with the control group,the study group experienced more blood loss,but shorter time to recovery of gastrointestinal function and length of hospital stay after the operation.After treatment,the study group also showed lower serum levels of IL-6,IL-8 and other inflammatory cytokines,improved treatment efficiency,and reduced tumor-related mortality and local recurrence(P<0.05).There was no significant differences in the incidence of postoperative wound infection,pulmonary infection,anastomotic leakage and other complications between the two groups(P>0.05).Conclusion Combined transanal and laparoscopic radical mesorectal excision for rectal cancer is feasible,safe,and therefore worthy of widespread clinical use.