不同远切缘距离的ISR在局部进展期直肠癌新辅助治疗后的临床研究

Clinical study of ISR with different distal incisal margin distances after neoadjuvant therapy for locally advanced rectal

目的研究不同远切缘距离的经括约肌间切除术(ISR)在局部进展期直肠癌(LARC)新辅助治疗后的临床效果。方法回顾性分析2019年6月至2022年6月52例LARC患者的临床资料。所有患者术前均接受新辅助放化疗(nCRT)后行ISR术,根据远切缘距离的不同分为A组(远切缘距离<1 cm,n=24)和B组(远切缘距离≥1 cm,n=28)。数据均应用软件SPSS 22.0处理。围手术期相关指标等计量资料采用(x±s)表示.组间比较行独立样本t检验;术后并发症等计数资料采用[例(%)]表示,行χ^(2)检验;生存分析采用Kaplan-Meier法并行Log-Rank检验。P<0.05表示差异有统计学意义。结果两组患者手术时间、术中出血量、淋巴结清扫数目、术后排气时间及术后住院时间比较,差异均无统计学意义(P>0.05)。两组患者术后切口感染、吻合口漏、吻合口出血、盆腔感染、肠梗阻及总并发症情况比较,差异也均无统计学意义(P>0.05)。术后随访(11~47)个月,中位随访时间30个月。通过Kaplan-Meier分析显示,两组患者的累积总生存率(70.8%vs.78.6%)与累积无病生存率(62.5%vs.75.0%)比较,差异均无统计学意义(Log-Rankχ^(2)=0.256.1.360,P=0.613.0.244)。结论ISR术中远切缘距离≥1 cm与远切缘距离<1cm在LARC患者nCRT后可获得相同的疗效,对患者的总体生存和无病生存并无显著影响。

Objective To compare the ffect of two prophylactie ileostomy methods in laparoscopic ISR for ultra-low rectal cancer.Methods The clinical data of 52 patients with LARC from June 2019 to June 2022 were retrospectively analyzed.All patients received neoadjuvant radiochemotherapy(nCRT)before receiving ISR and were divided into group A(distal margin distance<1 cm,n=24)and group B(distal margin distance≥1cm,n=28)according to the distance of distal margin.All data were processed by SPSS 22.0 software.Perioperative indicators and other measurement data were expressed by(x±s),and independent t test was performed for inter-group comparison.The statistical data of postoperative complications were represented by[cases(%)]andχ^(2)test was performed.Kaplan-Meier method and Log-Rank test were used for survival analysis.P<0.05 indicated that the difference was statistically significant.Results There were no significant differences in operation time,intraoperative blood loss,number of lymph node dissection,postoperative exhaust time and postoperative hospital stay between the lwo groups(P>0.05).There were no significant differences in incision infection,anastomotic leakage,anastomotic hemorrhage,pelvic infection,intestinal obstruction and total complications between the two groups(P>0.05).The median follow-up time was 30 months(11~47 months).Kaplan-Meier analysis showed that cumulative overall survival(70.8%vs.78.6%)and disease-free survival(62.5%vs.75.0%)were not significantly different between the two groups(Log-Rankχ^(2)=0.256,1.360,P=0.613,0.244).Conclusion Patients with LARC with a distance of≥1 cm and a distance of<1 cm at the distal incisional margin during ISR can achieve the same efficacy after nCRT,and the overall survival and disease-free survival of patients are not significantly afcted.