腹腔镜联合电子肛门镜在低位直肠癌保肛手术中临床应用探讨

Clinical effect of laparoscopy combined with electronic anoscope for anus-preserving surgery for low rectal cancer

目的探讨腹腔镜联合电子肛门镜在低位直肠癌保肛手术中的临床应用。方法选取2020-01-01-2021-01-01菏泽市立医院胃肠外科收治的70例低位直肠癌患者为研究对象,采用随机对照表法分为对照组和联合组,各35例。对照组患者行腹腔镜下直肠前切除术,术后常规放置肛管;联合组患者行腹腔镜联合电子肛门镜下直肠前切除术。对比2组患者的围手术期各种数据及吻合口出血、吻合口漏等并发症发生情况,并在手术后对患者进行12个月的随访,观察比较肿瘤复发情况。结果2组患者手术均顺利完成,没有出现中转开腹及保护性小肠造口病例。2组患者的性别、年龄、体质量指数(BMI)、肿瘤下缘距肛缘距离、肿瘤直径、肿瘤浸润深度、术中出血量、淋巴结清除数目、术后1年复发转移率等比较,差异无统计学意义,均P>0.05。联合组患者术后第1、2、3天疼痛评分分别为(2.8±0.2)、(2.0±0.1)、(1.8±0.2)分,均低于对照组的(4.5±0.3)、(4.0±0.2)、(3.1±0.3)分;联合组患者手术时间、首次下床活动时间、首次肛门排气时间、首次进食时间、总住院时间分别为(149.7±51.7)min、(1.5±0.1)d、(2.7±1.3)d、(1.9±0.2)d、(11.1±1.2)d,均短于对照组的(220.8±26.1)min、(2.7±1.6)d、(3.5±1.4)d、(3.0±0.3)d、(13.9±2.1)d;对照组出现并发症3例,联合组1例。联合组术后吻合口并发症发生率、疼痛评分、首次下床活动时间、肛门排气时间、首次进食时间、住院时间等均优于对照组,差异有统计学意义,均P<0.05。结论双镜联合手术治疗低位直肠癌可以降低吻合口并发症,减少住院时间,提高术后舒适度和生活质量,值得临床上推广应用。

Objective To explore the clinical effect of laparoscopy combined with electronic anoscope in anus-preserving surgery for low rectal cancer.Methods A retrospective analysis was performed on the clinical data of 70 patients with low rectal cancer admitted to Heze Municipal Hospital from Jan 2020 to Jan 2021.These patients were divided into the control group and the observation group according to randomized contrastive table,with 35 cases in each group.Patients in the control group were treated by laparoscopic total mesorectal excision.Anal canal was placed routinely after operation.Patients in the observation group were treated by laparoscopy combined with anoscopic radical resection.The operation related indexes and the complication rates such as stoma bleeding,incision leakage after operation were compared between the two groups.The patients were observed during a follow-up period of 12 months for tumor recurrence.Results The operations were successfully completed in both groups,and there were no cases of conversion to laparotomy or protective enterostomy.There was no significant difference between the two groups in terms of sex,age,body mass index(BMI)index,distance from lower edge of the tumor to anal edge,tumor diameter,tumor invasion depth,intraoperative blood loss,number of lymph node dissection,recurrence and metastasis rate 1 year after operation(P>0.05).The pain scores of patients in the combined group on the first,second and third days after operation were(2.8±0.2),(2.0±0.1)and(1.8±0.2)respectively,which were significantly lower than those of patients in the control group on the first,second and third days after operation(4.5±0.3),(4.0±0.2)and(3.1±0.3);The operation time,the first activity time,the first anal exhaust time,the first eating time,and the total hospitalization time of the patients in the combined group were(149.7±51.7)min,(1.5±0.1)d,(2.7±1.3)d,(1.9±0.2)d,and(11.1±1.2)d,respectively,which were significantly shorter than the operation time,the first activity time,the first anal exhaust time,the first eating time,and the total hospitalization time of the patients in the control group(220.8±26.1)min,(2.7±1.6)d,(3.5±1.4)d,(3.0±0.3)d,and(13.9±2.1)d;There were 3cases of complications in the control group and 1case in the combined group.The observation group was significantly better than the control group in terms of postoperative complications,pain index,time to ambulation,anal exhaust time,time to the first feeding and duration of hospital stay(P<0.05).Conclusion Laparoscopy combined with anoscopic radical resection in the treatment of low rectal cancer reduced anastomotic complications,hospital stay,and improved postoperative comfort and quality of life.It is worthy of clinical application.