筋膜导向腹腔镜直肠癌根治术的临床效果分析

The clinical effect analysis of fascial anatomy-guided laparoscopic radical resection for rectal cancer

目的分析筋膜导向腹腔镜直肠癌根治术的临床效果。方法回顾性分析广东省中医院2017年1月1日至2019年12月31日行腹腔镜直肠癌根治术的147例患者的临床资料,根据手术方式的不同,分为筋膜导向组(n=77)和层面导向组(n=70)。观察记录两组手术情况、术后情况,并随访6~12个月,了解两组患者术后生存、肿瘤复发和转移情况、术后排尿功能障碍发生情况和低位直肠前切除综合征发生情况。结果所有患者均顺利完成手术,无中转开腹病例。筋膜导向组的手术时间、住院时间、拔除盆腔引流管时间短于层面导向组,直肠系膜完整性优于层面导向组,总获取淋巴结数目多于层面导向组,第一天盆腔引流量少于层面导向组,差异均有统计学意义(均P<0.05)。筋膜导向组术后1个月排尿功能障碍的发生率为19.5%,低于层面导向组的34.3%,差异有统计学意义(P<0.05)。115例患者获得术后随访,随访率为78.2%。术后随访时间为6~12个月,中位随访时间为7个月。随访期间,无肿瘤复发、转移,无肿瘤相关死亡病例;两组排尿功能障碍发生率、低位直肠前切除综合征发生率及严重程度比较差异均无统计学意义(均P>0.05)。结论与层面导向腹腔镜直肠癌根治术相比,筋膜导向手术方法可缩短手术时间、术后住院时间及盆腔引流管拔除时间,同时在淋巴结清扫、保持系膜完整性和降低术后1个月内排尿功能障碍发生率方面更具优势。

Objectives To investigate the clinical effect of fascial anatomy-guided laparoscopic radical resection for rectal cancer.Methods This was a retrospective analysis of 147 patients who underwent laparoscopic radical resection for rectal cancer at the Guangdong Hospital of Traditional Chinese Medicine between January 1,2017 and December 31,2019.According to the surgical procedure,the patients were divided into fascial anatomy-guided surgery(FG,n=77)group and membrane anatomy-guided(MG,n=70)group.Surgical parameters and results were collected.Patients were followed up for 6 to 12 months to assess survival,recurrence,metastasis,and incidence of postoperative urinary dysfunction and low anterior resection syndrome(LARS).Results All procedures were uneventful,and there were no conversions to open surgery.The FG group had significantly shorter duration of surgery,duration of hospitalization,and duration of the pelvic drainage catheter use than the MG group(P<0.05).The integrity of the resected mesentery was better,the number of total lymph node yield was higher,and the volume of pelvic drainage at the 1st day postoperative was significantly less in the FG group(P<0.05).The incidence of urinary dysfunction one month after surgery was 19.5%in the FG group and 34.3%in the MG group,with significant differences between the two groups(P<0.05).One hundred and fifteen(78.2%)patients were followed up,with a follow-up period ranging between 6 and 12 months(median 7 months).During the follow-up,there were no recurrence,metastasis,or tumor-related deaths.The two groups did not differ significantly in the incidences of urinary dysfunction and LARS.The severity of patients who experienced these complications was similar between the two groups(P>0.05).Conclusion Compared with membrane anatomy-guided laparoscopic radical resection for rectal cancer,fascial anatomy-guided can shorten the duration of surgery,postoperative hospitalization,and duration of pelvic drainage catheter use while the number of total lymph node yield,maintaining the integrity of the mesentery,and reducing the risk of urinary dysfunction within 1 month after surgery.