腹腔镜全直肠系膜切除术对中低位直肠癌患者治疗效果及术后并发症的影响

Effect of Laparoscopic Total Mesorectal Excision on the Treatment Effect and Postoperative Complications of Patients with Middle and Low Rectal Cancer

目的研究腹腔镜全直肠系膜切除术对中低位直肠癌患者治疗效果及术后并发症的影响。方法选取2016年1月-2020年11月北京京西肿瘤医院诊治的280例中低位直肠癌患者为研究对象,采用随机数字表法分为对照组(n=140)和观察组(n=140)。对照组采用传统开腹根治术,观察组采用腹腔镜全直肠系膜切除术,比较两组临床手术指标、肛门功能指标[肛管静息压(ARP)、肛管最大收缩压(AMSP)、直肠最大耐受量(RMTV)]、肛门功能评分(Wexner)、并发症发生率、2年生存率、局部复发率以及远处转移率。结果观察组手术时间、术中出血量、术后肛门排气时间、术后进食时间以及住院时间均短于对照组(P<0.05);观察组ARP、AMSP小于对照组,RMTV大于对照组(P<0.05);观察组Wexner评分低于对照组(P<0.05);观察组并发症总发生率为10.71%,低于对照组的22.86%(P<0.05);随访2年,观察组生存率与对照组比较,差异无统计学意义(P>0.05),但观察组局部复发率、远处转移率均低于对照组(P<0.05)。结论腹腔镜全直肠系膜切除术治疗中低位直肠癌可减少手术时间、术中出血量,缩短术后肛门排气、进食时间以及住院时间、降低术后并发症,保护肛门功能,改善患者远期预后,具有相对较理想的应用效果。

Objective To study the effect of laparoscopic total mesorectal excision on the treatment effect and postoperative complications of patients with middle and low rectal cancer.Methods A total of 280 patients with middle and low rectal cancer diagnosed and treated in Beijing Jingxi Tumor Hospital from January 2016 to November 2020 were selected as the research objects,and they were divided into control group(n=140)and observation group(n=140)by random number table method.The control group was treated with traditional open radical resection,and the observation group was treated with laparoscopic total mesorectal excision.The clinical operation indexes,anal function indexes[anal resting pressure(ARP),anal maximum systolic pressure(AMSP),rectal maximum tolerated dose(RMTV)],anal function score(Wexner),complication rate,2-year survival rate,local recurrence rate and distant metastasis rate were compared between the two groups.Results The operation time,intraoperative blood loss,postoperative anal exhaust time,postoperative feeding time and hospitalization time of the observation group were shorter than those of the control group(P<0.05).ARP and AMSP in the observation group were smaller than those in the control group,and RMTV was larger than that in the control group(P<0.05).The Wexner score of the observation group was lower than that of the control group(P<0.05).The total incidence of complications in the observation group was 10.71%,which was lower than 22.86%in the control group(P<0.05).After 2 years of follow-up,there was no significant difference in the survival rate between the observation group and the control group(P>0.05),but the local recurrence rate and distant metastasis rate in the observation group were lower than those in the control group(P<0.05).Conclusion Laparoscopic total mesorectal excision in the treatment of middle and low rectal cancer can reduce the operation time,intraoperative blood loss,postoperative anal exhaust,eating time and hospitalization time,reduce postoperative complications,protect anal function,and improve the long-term prognosis of patients.It has a relatively ideal application effect.