直线切割吻合器行经肛门局部切除术联合放化疗治疗T2N0M0期低位直肠癌的安全性及疗效

Efficacy and safety of transanal local resection combined with radiotherapy and chemotherapy with linear cutting stapler for T2N0M0 low rectal cancer

目的探讨在T2N0M0期低位直肠癌治疗中,应用直线切割吻合器行经肛门局部切除术联合放化疗的疗效及安全性。方法回顾性分析2017年2月至2019年2月在河北北方学院附属第一医院接受诊治的57例T2N0M0期低位直肠癌患者的临床资料,按不同手术方式分成经肛门局部切除术联合放化疗组(TAE组,27例)和传统根治术组(RS组,30例)。比较两组患者一般资料、手术相关指标、Wexner便秘评分及生活质量量表(QLQ-C30)评分、术后并发症及随访情况。结果两组手术时间、术后住院天数、术中出血量比较,TAE组明显低于RS组,差异有统计学意义(P<0.05)。术后1个月评估,TAE组术后Wexner评分明显低于RS组(2.10±1.40 vs 6.60±2.10,t=9.041,P<0.01),QLQ-C30评分明显高于RS组(90.31±3.32 vs 71.59±6.35,t=13.716,P<0.01)。TAE组并发症发生率较RS组有所降低,但差异无统计学意义(3.70%vs 23.33%,P>0.05)。两组均随访3年及以上,仅TAE组复发1例,RS组无复发。结论对T2N0M0期低位直肠癌使用直线切割吻合器行经肛门局部切除术联合放化疗的治疗方法,可缩短手术时间、术后住院天数,减少术中出血量,改善术后排便功能及患者生活质量,不增加远期复发率。

Objective To investigate the efficacy and safety of transanal local resection combined with radiotherapy and chemotherapy with linear cutting stapler in the treatment of stage T2N0M0 low rectal cancer.Methods The clinical data of 57 patients with stage T2N0M0 low rectal cancer treated in the First Affiliated Hospital of Hebei North University from February 2017 to February 2019 were retrospectively analyzed,and they were divided into two groups according to different surgical methods:transanal local resection combined with radiotherapy and chemotherapy group(TAE group,27 cases)and traditional radical surgery group(RS group,30 cases).The general data,operation related indexes,Wexner score and QLQ-C30 score,postoperative complications and follow-up outcomes were compared between two groups.Results The operation time,postoperative hospitalization days and intraoperative bleeding volume in TAE group were significantly lower than those in RS group(P<0.05).The postoperative Wexner score of TAE group was significantly lower than that in RS group(2.10±1.40 vs 6.60±2.10,t=9.041,P<0.01).QLQ-C30 score in TAE group was significantly higher than that in RS group(90.31±3.32 vs 71.59±6.35,t=13.716,P<0.01).The incidence of complications in TAE group decreased compared to RS group without significant difference(3.70%vs 23.33%,P>0.05).Both groups were followed up for 3 years or more,with only 1 recurrence in TAE group and no recurrence in RS group.Conclusion The use of linear cutting stapler for transanal local resection combined with radiotherapy and chemotherapy for low rectal cancer can shorten the operation time and postoperative hospital stay,reduce intraoperative bleeding,improve the postoperative defecation and the quality of life of patients,and it does not increase the long-term recurrence rate.