比较CSPO和ISR治疗超低位直肠癌的保肛效果

Comparison of Anus-preserving Effects of CSPO and ISR in the Treatment of Ultra-low Rectal Cancer

目的:比较适形切除保肛术(CSPO)和经内外括约肌间切除术(ISR)治疗超低位直肠癌的保肛效果。方法:选择2020年6月至2022年3月选择在本院诊治的超低位直肠癌患者63例作为研究对象,根据随机分配原则把患者分为ISR组31例与CSPO组32例,ISR组予经内外括约肌间切除术治疗,CSPO组予适形切除保肛术治疗,记录与随访患者的近期与远期预后。结果:所有患者都顺利完成保肛,两组的术中出血量、淋巴结清扫数目对比无差异(P>0.05),CSPO组的手术时间、术后肠道功能恢复时间、术后住院时间明显少于ISR组(P<0.05)。CSPO组的术后7 d的切口感染、泌尿系感染、吻合口狭窄、吻合口瘘等并发症发生率为6.3%,明显低于ISR组的29.0%(P<0.05)。CSPO组术后1 d、3 d、7 d的血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)含量都明显少于ISR组(P<0.05)。ISR组术后3个月的满意度为80.6%,明显低于CSPO组100.0%(P<0.05)。结论:相对经内外括约肌间切除术,适形切除保肛术治疗超低位直肠癌能有效抑制血清PCT与hs-CRP的表达,具有很好的保肛效果,能减少并发症的发生,还可促进患者康复,从而持续提高患者的随访生存率。

Objective: To compare the anus-preservation effects of conformal sphincter-preserving operation(CSPO) and intersphincteric rectal resection(ISR) in the treatment of ultra-low rectal cancer. Methods: 63 patients with ultra-low rectal cancer who were diagnosed and treated in our hospital from June 2020 to March 2022 were selected as the research subjects. According to the principle of random allocation, the patients were divided into the ISR group with 31 cases and the CSPO group with 32 cases. Intersphincterectomy was performed, and the CSPO group was treated with conformal excision and sphincter preservation. The short-term and long-term prognosis of the patients were recorded and followed up. Results: All patients were successfully completed sphincter preservation. There was no difference in intraoperative blood loss and number of lymph node dissections compared between the two groups(P>0.05). The operative time, postoperative bowel function recovery time, and postoperative hospital stay in the CSPO group were less than the ISR group(P<0.05).There was no difference in intraoperative blood loss and number of lymph node dissections compared between the two groups(P>0.05).The incidence rates of complications such as incision infection, urinary tract infection, anastomotic stenosis and anastomotic leakage in CSPO group was 6.3 % at 7 days after operation, which was significantly lower than 29.0 % in ISR group(P<0.05). The levels of serum procalcitonin(PCT) and high-sensitivity C-reactive protein(hs-CRP) in CSPO group were lower than those in ISR group at 1 d, 3 d, and7 d after operation(P<0.05). The satisfaction rate 3 months after the operation in the ISR group were 80.6 %, which were lower than that in the CSPO group(100.0 %)(P<0.05). Conclusion: Compares with internal sphinctectomy, conformal excision and sphincter-preserving surgery can effectively inhibit the expression of serum PCT and hs-CRP in the treatment of ultra-low rectal cancer. recovery, thereby continuing to improve the satisfaction rate of patients.