腹腔镜下经肛门拖出式吻合保肛术治疗低位直肠癌的临床疗效及安全性

Clinical efficacy and safety of laparoscopic anal pull-out anastomosis preservation operation in the treatment of low rectal cancer

目的探讨腹腔镜下经肛门拖出式吻合保肛术治疗低位直肠癌的临床疗效及安全性。方法根据治疗方法的不同将123例低位直肠癌患者分为A组(n=59,采用腹腔镜下经肛门拖出式吻合保肛术)和B组(n=64,采用直肠癌低位前切术)。比较两组患者的手术情况、术后排便功能、炎性因子[白细胞(WBC)、C反应蛋白(CRP)和白细胞介素-6(IL-6)]水平、并发症发生率及术后6个月局部复发率。结果A组患者的手术时间、住院时间、止痛时间及肠道功能恢复时间均明显短于B组(P﹤0.01)。术后,A组患者的排便功能优良率高于B组(P﹤0.05)。术后24、48 h,两组患者的WBC、CRP及IL-6水平均高于本组术前,且A组患者的WBC、CRP及IL-6水平均低于B组,差异均有统计学意义(P﹤0.05)。两组患者吻合口出血、吻合口瘘的发生率及术后6个月局部复发率比较,差异均无统计学意义(P﹥0.05)。结论腹腔镜下经肛门拖出式吻合保肛术治疗低位直肠癌的临床疗效显著,能够改善患者的排便功能,炎性反应轻微且安全性较高。

Objective To investigate the clinical efficacy and safety of laparoscopic anal pull-out anastomosis preservation operation in the treatment of low rectal cancer.Method A total of 123 patients with low rectal cancer were divided into group A(n=59,received laparoscopic anal pull-out anastomosis preservation operation)and group B(n=64,received low anterior resection of rectal cancer).The operation situation,postoperative defecation function,inflammatory factors[white blood cell(WBC),C-reactive protein(CRP)and interleukin-6(IL-6)]levels,complications and local recurrence rate at 6 months after operation were compared between the two groups.Result The operation time,hospitalization time,pain alleviation time and recovery time of intestinal function in group A were shorter than those in group B(P<0.01).After operation,the excellent rate of defecation function in group A was better than that in group B(P<0.05).At24 h and 48 h after operation,the WBC,CRP and IL-6 levels in both groups were higher than those before operation,with lower levels in group A than those in group B(P<0.05).There were no significant differences in the incidence of anastomotic bleeding,anastomotic fistula and local recurrence at 6 months after operation between the two groups(P>0.05).Conclusion Laparoscopic anal pull-out anastomosis preservation operation can achieve significant clinical efficacy in the treatment of low rectal cancer,which can improve the defecation function,decrease the inflammatory response with higher safety.