经肛门内镜微创手术与传统开腹手术治疗直肠癌的效果观察

Effect of transanal endoscopic microsurgery and traditional laparotomy on patients with rectal cancer

目的探讨经肛门内镜微创手术(TEM)与传统开腹手术治疗直肠癌的效果及对患者术后胃肠功能恢复的影响。方法本研究为随机对照试验。选择2019年5月至2022年5月在聊城市第三人民医院进行治疗的80例直肠癌患者为研究对象,随机分为观察组和对照组,各40例。观察组男26例,女14例,年龄(49.25±7.63)岁,行TEM治疗;对照组男24例,女16例,年龄(50.63±7.24)岁,行传统开腹手术治疗。比较两组手术各项指标、手术前后胃肠激素[胃动素、胃泌素]水平、术后胃肠功能恢复情况、手术前后肛门功能情况以及并发症发生情况。统计学方法采用独立样本t检验、配对t检验、χ^(2)检验。结果观察组手术时间[(60.57±11.29)min比(143.35±32.54)min]、出血量[(62.93±15.43)ml比(137.69±36.47)ml]、住院时间[(7.45±1.26)d比(12.37±3.13)d]均优于对照组(均P<0.001),两组淋巴结清扫数量、标本长度比较差异均无统计学意义(均P>0.05)。手术后两组胃动素、胃泌素均低于手术前(均P<0.05),但术后观察组胃动素[(253.16±30.57)ng/L比(219.25±29.52)ng/L]、胃泌素水平[(141.24±11.17)μmol/L比(103.65±10.43)μmol/L]均高于对照组(均P<0.001)。手术后观察组胃肠功能恢复情况均优于对照组(均P<0.001)。手术后,两组大便失禁严重度(Wexner)评分均高于手术前,肛管静息压(ARP)、肛管最大收缩压(MSP)均低于手术前,差异均有统计学意义(均P<0.05);观察组Wexner评分低于对照组[(7.23±1.56)分比(9.58±1.94)分,t=5.970,P<0.001],两组ARP、MSP水平比较差异均无统计学意义(均P>0.05)。观察组并发症总发生率低于对照组[5.00%(2/40)比20.00%(8/40)],两组比较差异有统计学意义(χ^(2)=4.114,P=0.043)。结论TEM与传统开腹手术均可有效治疗直肠癌,其中TEM对胃肠激素水平影响较小,更利于缩短恢复时间,进一步促进胃肠功能与肛门功能恢复,且术后并发症发生率较低,临床应用价值较高。

Objective To investigate the effects of transanal endoscopic microsurgery(TEM)and traditional laparotomy on the postoperative recovery of gastrointestinal function in patients with rectal cancer.Methods It was a randomized controlled trial.A total of 80 patients with rectal cancer treated in The Third People's Hospital of Liaocheng from May 2019 to May 2022 were selected as research objects and were randomly divided into an observation group and a control group,with 40 cases in each group.In the observation group,there were 26 males and 14 females,aged(49.25±7.63)years;in the control group,there were 24 males and 16 females,aged(50.63±7.24)years.The observation group received TEM,and the control group received traditional laparotomy.The surgery related indexes,levels of gastrointestinal hormones(motilin and gastrin)before and after surgery,postoperative gastrointestinal function recovery,anal function before and after surgery,and incidences of complications were compared between the two groups.Independent sample t test,paired t test,andχ^(2) test were used for statistical analysis.Results The operation time[(60.57±11.29)min vs.(143.35±32.54)min],blood loss[(62.93±15.43)ml vs.(137.69±36.47)ml],and hospital stay[(7.45±1.26)d vs.(12.37±3.13)d]in the observation group were all better than those in the control group(all P<0.001),but there were no statistically significant differences in the number of lymph nodes dissected and length of specimens between the two groups(both P>0.05).The motilin and gastrin levels in both groups after surgery were lower than those before surgery(all P<0.05);the levels of motilin[(253.16±30.57)ng/L vs.(219.25±29.52)ng/L]and gastrin[(141.24±11.17)μmol/L vs.(103.65±10.43)μmol/L]in the observation group were higher than those in the control group(both P<0.001).The recovery of gastrointestinal function in the observation group was better than that in the control group(P<0.001).After surgery,the Wexner scores of fecal incontinence severity of the two groups were higher than those before surgery,the anal canal resting pressure(ARP)and anal canal maximum systolic pressure(MSP)were lower than those before surgery,with statistically significant differences(all P<0.05).The Wexner score of the observation group was lower than that of the control group[(7.23±1.56)points vs.(9.58±1.94)points,t=5.970,P<0.001],and there were no statistically significant differences in the levels of ARP and MSP between the two groups(both P>0.05).The total incidence of complications in the observation group was lower than that in the control group[5.00%(2/40)vs.20.00%(8/40)],with a statistically significant difference between the two groups(χ^(2)=4.114,P=0.043).Conclusion Both TEM and traditional laparotomy can effectively treat rectal cancer,among which TEM has little effect on gastrointestinal hormone levels,is more conducive to shorten the recovery time and further promote the recovery of gastrointestinal function and anal function,and has a lower incidence of postoperative complications and high clinical application value.