局部进展期直肠癌新辅助治疗后腹腔镜TaTME与TME中的对比研究

A comparative study of laparoscopic TaTME and TME after neoadjuvant therapy for locally advanced rectal cancer

目的:对比局部进展期直肠癌新辅助治疗后腹腔镜下行经肛全直肠系膜切除术(TaTME)与全直肠系膜切除术(TME)中的临床疗效。方法:回顾性分析2020年1月至2022年12月接受治疗的72例局部进展期直肠癌(LARC)患者的临床资料,采用随机数字表法将患者分为TaTME组和TME组,每组患者各36例,所有患者均于术前接受新辅助治疗(NAT)后行腹腔镜手术,TaTME组于腹腔镜下行TaTME,TME组于腹腔镜下行TME。使用软件SPSS 22.0分析数据,围手术期相关指标、大便失禁严重度(Wexner)评分及国际前列腺症状(IPSS)评分等计量资料采用(x±s)表示,行独立样本t检验;术后并发症等计数资料采用[例(%)]表示,采用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:TaTME组患者手术时间、术中出血量、肛门首次排气时间及术后住院时间相较于TME组明显降低(P<0.05),而TME标本的完整性却明显升高(P<0.05);TaTME组和TME组患者淋巴结清扫枚数、远切缘长度、CRM阳性率及术后并发症情况比较均未见统计学差异(P>0.05)。TaTME组患者Wexner及IPSS评分相较于TME组均明显降低(P<0.05),IIEF-5评分明显升高(P<0.05)。通过Kaplan-Meier分析显示,TaTME组和TME组患者的累积总生存率(88.9%vs.83.3%)及累积无病生存率(86.1%vs.80.6%)比较,差异均无统计学意义(P>0.05)。结论:与腹腔镜TME相比,LARC患者NAT后行腹腔镜TaTME获得了更好的疗效,在不影响患者术后生存的前提下,缩短了手术时间,减少了术中损伤,加快了术后恢复,提高了TME的完整性,并使肛门、前列腺及性功能得到了明显改善。

Objective:To compare the clinical efficacy of laparoscopic transanal mesenterectomy(TaTME)and total mesenterectomy(TME)after neoadjuvant treatment for locally advanced rectal cancer.Methods:The clinical data of 72 patients with locally advanced rectal cancer(LARC)who received treatment from January 2020 to December 2022 were retrospectively analyzed.The patients were divided into TaTME group and TME group by random number table method,with 36 patients in each group.All patients underwent laparoscopic surgery after receiving neoadjuvant therapy(NAT)before surgery.The TaTME group underwent laparoscopic TaTME,and the TME group underwent laparoscopic TME.SPSS 22.0 software was used to analyze the data.Perioperative related indicators,fecal incontinence severity(Wexner)score,international prostatic symptoms(IPSS)score and other measurement data were expressed by(x±s),and independent sample t test was used.The statistical data of postoperative complications were represented by[cases(%)]andχ^(2) test was used.Kaplan-Meier method and Log-Rank test were used for survival analysis.P<0.05 indicated that the difference was statistically significant.Results:Compared with TME group,the operation time,intraoperative blood loss,first anal exhaust time and postoperative hospital stay in TaTME group were significantly reduced(P<0.05),while the integrity of TME specimens was significantly increased(P<0.05).There were no significant differences in the number of lymph nodes dissection,length of distal resection margin,positive rate of CRM and postoperative complications between TaTME group and TME group(P>0.05).Wexner and IPSS scores in TaTME group were significantly lower than those in TME group(P<0.05),while IIEF-5 scores were significantly higher(P<0.05).Kaplan-Meier analysis showed that there was no significant difference in cumulative overall survival(88.9%vs.83.3%)and cumulative disease-free survival(86.1%vs.80.6%)between the TaTME group and the TME group(P>0.05).Conclusion:Compared with laparoscopic TME,laparoscopic TaTME after NAT in LARC patients has achieved better efficacy.On the premise of not affecting the postoperative survival of patients,it shorens the operation time,reduces intraoperative injury,accelerates postoperative recovery,improves the integrity of TME,and significantly improves the anal,prostate and sexual functions.