腹腔镜与开腹直肠癌Miles手术的临床应用及对会阴部伤口愈合的影响

Clinical application of Miles surgery for laparoscopic and laparotomy for rectal cancer and analysis of its effect on perineal wound healing

目的探讨腹腔镜与开腹直肠癌Miles手术的临床应用效果及对会阴部伤口愈合的影响。方法选取2015年6月至2017年2月江苏省邳州市人民医院收治的98例直肠癌患者,采用随机数字表法随机分为观察组和对照组,每组49例。观察组患者采用腹腔镜Miles手术治疗,对照组患者采用开腹Miles手术治疗,比较两组的手术情况、肛肠测压结果、保肛率、生存率、术后并发症及会阴部伤口愈合情况。结果观察组的手术时间、术后肛门排气时间、术后首次进食时间、住院时间短于对照组,术中出血量、腹腔引流量少于对照组,差异均有显著性(P<0.05)。两组术前肛肠压力比较差异无显著性(P>0.05),术后1年肛肠压力均低于术前,且对照组明显低于观察组,差异有显著性(P<0.05)。观察组保肛率(85.71%)明显高于对照组(69.39%),差异有显著性(P<0.05),但两组术后半年、1年、2年生存率比较差异无显著性(P>0.05)。观察组的并发症发生率低于对照组,会阴部伤口愈合时间短于对照组、愈合率高于对照组,差异均有显著性(P<0.05)。结论腹腔镜Miles手术治疗直肠癌的保肛率及会阴部伤口愈合率高,对肛肠压力影响小,康复时间短,术后并发症少,预后更佳,值得临床应用。

Objective To investigate the clinical effect of laparoscopic and open Miles surgery for rectal cancer and its effect on perineal wound healing.Method Ninety-eight patients with rectal cancer admitted to Pizhou People’s Hospital of Jiangsu Province from June 2015 to February 2017 were randomly divided into observation group and control group,with 49 patients in each group.Patients in the observation group were treated with laparoscopic Miles surgery,while patients in the control group were treated with open Miles surgery.The operation status,anorectal pressure measurement results,anal preservation rate,survival rate,postoperative complications and perineal wound healing were compared between the two groups.Result The operative time,postoperative anal exhaust time,postoperative first feeding time and hospitalization time of the observation group were shorter than those of the control group,and the intraoperative blood loss and intraperitoneal drainage were less than those of the control group,with significant differences(P<0.05).There was no significant difference in preoperative anorectal pressure between the two groups(P>0.05).One year after the operation,the anorectal pressure was lower than that before the operation,and the control group was significantly lower than the observation group,with a significant difference(P<0.05).The rate of anal preservation in the observation group(85.71%)was significantly higher than that in the control group(69.39%),with a significant difference(P<0.05),but there was no significant difference in the survival rate between the two groups(P>0.05).The incidence of complications in the observation group was lower than that in the control group,the healing time of perineal wounds was shorter than that in the control group,and the healing rate was higher than that in the control group,with significant differences(P<0.05).Conclusion Laparoscopic Miles surgery for rectal cancer has a high rate of anal preservation and perineal wound healing,with little impact on anal pressure,short recovery time,fewer postoperative complications,and better prognosis,which is worthy of clinical application.