腹腔镜经括约肌间切除术在低位直肠癌患者中的应用效果

Application effect of laparoscopic trans-sphincterectomy in patients with low rectal cancer

目的探讨腹腔镜经括约肌间切除术在低位直肠癌患者中的应用效果。方法根据手术方式的不同将200例低位直肠癌患者分为对照组(n=100)和观察组(n=100),对照组患者采用传统开腹手术治疗,观察组患者采用腹腔镜经括约肌间切除术治疗,两组患者均予以快速康复外科干预。比较两组患者的手术相关指标、肛门直肠动力学指标[肛管静息压(ARP)、直肠最大耐受容量(RMTV)和肛管最大收缩压(AMSP)]、肛门功能(Wexner评分法)及并发症发生情况。结果观察组患者的术中出血量明显少于对照组,手术时间、首次肛门排气时间、首次下床活动时间、术后住院时间均明显短于对照组,差异均有统计学意义(P﹤0.01)。术后3个月,两组患者的ARP、RMTV、AMSP均低于本组术前,且观察组患者的ARP、RMTV、AMSP均低于对照组,差异均有统计学意义(P﹤0.05)。术后3、6个月,两组患者的Wexner评分均高于本组术前,观察组患者的Wexner评分均低于对照组,差异均有统计学意义(P﹤0.05)。观察组患者的并发症总发生率低于对照组(P﹤0.05)。结论腹腔镜经括约肌间切除术治疗低位直肠癌能够减少患者术中出血量,促进患者术后恢复,缩短住院时间,改善肛门功能,且具有较高的安全性。

Objective To investigate the application effect of laparoscopic trans-sphincterectomy in patients with low rectal cancer.Method A total of 200 patients with low rectal cancer were divided into control group(n=100,treated with traditional open surgery)and observation group(n=100,treated with laparoscopic trans-sphincterectomy),and both groups received rapid rehabilitation surgical intervention.Operation-related indexes,ano-rectal dynamics indexes[anal resting pressure(ARP),rectal maximum tolerable volume(RMTV)and anal maximum squeeze pressure(AMSP)],anal function(Wexner scoring)and complications were compared between the two groups.Result The intraoperative blood loss in the observation group was lower,the operation time,the first anal exhaust time,the first ambulation time and hospital stay time were shorter than those in the control group(P<0.01).Three months after operation,the ARP,RMTV and AMSP in the two groups were lower than those before operation,with lower levels in the observation group than those in the control group(P<0.05).Three and six months after operation,the Wexner scores of both groups in the two groups were higher than those before operation,with lower scores in the observation group than those in the control group(P<0.05).The total incidence of complications in the observation group was lower than that in the control group(P<0.05).Conclusion Laparoscopic trans-sphincterectomy for low rectal cancer can reduce intraoperative blood loss,promote postoperative recovery,shorten hospital stay,effectively improve the anal function of patients,and with higher safety.