腹腔镜辅助经肛全直肠系膜切除术治疗直肠癌的临床疗效分析

Clinical efficacy analysis of laparoscopic-assisted transanal total mesorectal excision in the treatment of rectal cancer

目的:评价腹腔镜辅助经肛全直肠系膜切除术(transanal total mesorectal excision,TaTME)治疗直肠癌的可行性、安全性、根治性和近期临床疗效。方法:回顾性分析2018年12月至2019年12月我院收治的58例中低位直肠癌患者(肿瘤下缘距肛缘的距离≤10 cm)的临床资料。其中28例行腹腔镜辅助经肛全直肠系膜切除术(TaTME组),30例行腹腔镜全直肠系膜切除术(LaTME组)。比较两组的相关临床指标。结果:两组患者在年龄、性别、肿瘤下缘距肛缘的距离、肿瘤浸润深度等一般资料差异无统计学意义,具有可比性(P>0.05)。TaTME组手术时间为(187.82±38.99)min,LaTME手术时间为(113.00±21.84)min,两组差异有显著意义(P<0.001);两组术中出血量[(75.00±18.40)mL vs(73.16±17.88)mL]、术后镇痛时间[(1.93±0.71)d vs(1.83±0.64)d]、肠功能恢复时间[(1.76±0.58)d vs(1.75±0.58)d]及住院时间[(8.43±3.51)d vs(8.07±3.29)d]相比较,差异无统计学意义(P>0.05);术后并发症TaTME组和LaTME组两者无显著差异(P>0.05)。两组在标本切除长度,肠管远切缘距离方面比较无差异;两组远处切缘所在病理学检查为阴性。两组随访时间到至今,所选入组为T3期以下,患者复查无瘤生存。结论:TaTME在游离低位直肠以及系膜更有优势,改善“困难骨盆”的低位直肠癌病人的手术切除和标本质量;同时手术安全可行,在手术并发症、手术死亡率等近期疗效方面与腹腔镜TME手术相当。

Objective:To evaluate the feasibility,safety,radical and short-term clinical efficacy of laparoscopic-assisted TaTME in the treatment of rectal cancer.Methods:A retrospective analysis of the clinical data of 58 patients with middle and low rectal cancer(the distance between the lower edge of the tumor and the anal edge≤10 cm)ad⁃mitted to our hospital from December 2018 to December 2019.Among them,28 cases underwent laparoscopic-assis⁃ted transanal total mesorectal excision(TaTME group),and 30 cases underwent laparoscopic total mesorectal excision(LaTME group).To compare the relevant clinical indicators of the two groups.Results:The two groups of patients had no statistically significant differences in general data such as age,gender,distance from the lower edge of the tumor to the anal edge,and depth of tumor invasion,and they were comparable(P>0.05).The operation time of the TaTME group was(187.82±38.99)min,and the operation time of LaTME was(113.00±21.84)min.The differ⁃ence between the two groups was significant(P<0.001).Introoperative blood loss[(75.00±18.40)mL vs(73.16±17.88)mL],the time of postoperative analgesia[(1.93±0.71)d vs(1.83±0.64)d],intestinal function recov⁃ery time[(1.76±0.58)d vs(1.75±0.58)d]and hospitalization time[(8.43±3.51)d vs(8.07±3.29)d],there was no difference statistical significance(P>0.05).Postoperative complications were not significantly different between the TaTME group and the LaTME group(P>0.05).The two groups had no difference in the length of speci⁃men resection and the distance of the distal resection margin of the bowel.The pathological examination of the distal resection margin of the two groups was negative.The follow-up time of the two groups has been up to now,and the selected group is below T3,and the patients are reexamined and survived without tumor.Conclusion:TaTME has ad⁃vantages in dissociating the low rectum and mesangium,improves the surgical resection and specimen quality of low rectal cancer patients with"difficult pelvis".At the same time,it is safe and feasible,and it is equivalent to traditional TME surgery in terms of surgical complications,surgical mortality and other short-term effects.