腹腔镜经肛全直肠系膜切除术治疗低位直肠癌的对照研究

A comparative study of laparoscopic transanal total mesentery for low rectal cancer

目的分析腹腔镜辅助经肛全直肠系膜切除术(TaTME)治疗低位宜肠癌的临床疗效,并探讨并发症预防措施。方法选取2017年3月至2019年3月98例低位直肠癌手术患者为研究对象,随机分为两组,每组各49例,TaTME组采用腹腔镜辅助TaTME术,ISR组采用腹腔镜辅助经腹括约肌间切除术(ISR)。采用软件SPSS19.0进行数据分析。围手术期相关指标.Wexner评分等计量资料以(x±s)表示,采用独立样本t检验;术后并发症等计数资料采用χ^(2)检验;肛门Kirwan分级采用Z检验。以P<0.05表示差异有统计学意义。结果本研究中两组患者均顺利完成手术,无中转开腹者。TaTME组患者术后首次进食时间、首次下床活动时间、住院时间、住院总费用方面均优于ISR组(P<0.05);术后6个月TaTME组患者的Wexner评分及Kirwan分级明显优于ISR组(P<0.05);TaTME组患者术后肠阻梗、肛门疼痛的发生率均显著低于ISR组(P<0.05).结论腹腔镜辅助TaTME术是一种安全可行的保肛手术,术后患者肛门功能恢复快,住院费用低,值得临床推广应用。

Objective To analyze the clinical efficacy of laparoscopic-assisted transanal total mesenterectomy(TaTME)in the treatment of low rectal cancer and to explore the preventive measures of complications.Methods A total of 98 patients undergoing low rectal cancer surgery from March 2017 to March 2019 were selected as the research subjects,and randomly divided into two groups,with 49 patients in each group.The TaTME group received laparoscopic-assisted TaTME surgery,and the ISR group received laparoscopic-assisted transsphincterectomy(ISR).SPSS19.0 software was used for analysis.Perioperative related indicators,Wexner score and other measurement data were expressed as(x±s),and independent t test was used.χ^(2)test was used for counting data of postoperative complications.Anal Kirwan grading was performed by Z test.P<0.05 indicated that the difference was statistically significant.Results In this study,both groups of patients successfully completed the surgery,no patients transferred to open surgery.TaTME group was superior to ISR group in terms of first postoperative feeding time,first time out of bed activity,length of stay and total hospitalization expenses(P<0.05).6 months after surgery,Wexner score and Kirwan grading of TaTME group were significantly better than that of ISR group(P<0.05).The incidence of postoperative intestinal obstruction and anal pain in the TaTME group was significandy lower than that in the ISR group(P<0.05).Condusion Laparoscopic assisted TaTME is a safe and feasible anus-preserving operation,with quick recovery of postoperative anal function and low hospitalization cost,which is worthy of clinical application.