腹腔镜下Dixon与Miles手术治疗Ⅲ期低位直肠癌远期疗效及影响因素

Analysis of long-term curative effect and influencing factors of laparoscopic Dixon and Miles surgery for the treatment of stage Ⅲ low rectal cancer

目的 探讨腹腔镜下Dixon与Miles术治疗Ⅲ期低位直肠癌的远期疗效及预后影响因素.方法 将110例Ⅲ期低位直肠癌患者按手术方式分为Miles组(55例)及Dixon组(55组),比较两组术中及术后恢复情况、3年复发率和生存率,并分析影响预后的因素.结果 Dixon组手术时间及住院时间显著短于Mils组(P<0.01),出血量显著少于Mils组(P<0.01),下床活动时间、术后排气时间显著早于Mils组(P<0.01);两组淋巴结清扫数目、并发症发生率、3年生存率及复发率比较差异无统计学意义(P>0.05).回归分析显示,肿瘤直径、癌胚抗原水平、淋巴结转移数、新辅助放化疗是Ⅲ期低位直肠癌预后的独立影响因素.结论 腹腔镜下Dixon手术与Miles手术治疗Ⅲ期低位直肠癌效果相当,但Dixon术具有创伤小、恢复快、可保留肛门功能等优点;影响患者预后的因素众多,应综合患者具体情况制定诊疗方案.

Objective To invesigate the long-term curative effect and influencing factors of laparoscopic Dixon and Miles surgery for the treatment of stage IK low rectal cancer.Methods 110 patients with stage Ⅲ low rectal cancer were divided into Miles group(55 cases)and Dixon group(55 groups)according to the operation method.The intraoperative and postoperative recovery,3-year recurrence rate and survival rate were compared between the two groups,and the factors affecting the prognosis were analyzed.Results The operation time and hospital stay in the Dixon group were significantly shorter than those in the Mils group(P<0.01),the bleeding volume was significantly less than in the Mils group(P<C 0.01)>and the time to get out of bed and the postoperative exhaust time were significantly earlier than those in the Mils group(P<0.01).There was no significant difference in the number of lymph node dissection,complication rate,3-year survival rate and recurrence rate between the two groups(P>0.05).Logistic regression analysis showed size of tumors,level of CEA,lymph node metastasis and neoadjuvant radiotherapy and chemotherapy were independent factors for prognosis.Conclusions Laparoscopic Dixon surgery is equivalent to Miles surgery in the treatment of stage Ⅲ low rectal cancer.However,Dixon surgery has the advantages of less trauma,fast recovery,and preservation of anal function.There are many factors affecting the prognosis of patients,and the diagnosis and treatment plan should be formulated based on the specific conditions of the patient.