Lap-TaTME在拟行保肛手术的低位直肠癌患者中的应用效果分析

Analysis of the Application Effect of Lap-TatME in Low Rectal Cancer Patients Undergoing Anal Sphincter Preservation Surgery

目的:观察腹腔镜辅助经肛全直肠系膜切除术(Lap-TaTME)在拟行保肛手术的低位直肠癌患者中的应用效果。方法:选取2022年1月—2024年2月德化县医院收治的50例低位直肠癌拟行保肛手术患者。根据随机数表法将其分为对照组及研究组,各25例。对照组给予全直肠系膜切除术(TME),研究组给予Lap-TaTME。比较两组围手术期指标,恢复情况,术后3个月的肛门功能,手术中转率,肿瘤近期不良预后。结果:研究组术中出血量少于对照组,手术时间长于对照组,差异有统计学意义(P<0.05)。研究组切口愈合时间、住院时间均短于对照组,术后肛门排气时间、下床活动时间均显著早于对照组,差异有统计学意义(P<0.05)。术后3个月,研究组Wexner评分低于对照组,差异有统计学意义(P<0.05)。研究组手术中转率为8.00%(2/25),低于对照组的36.00%(9/25),差异有统计学意义(P<0.05)。两组近期不良预后发生率比较,差异无统计学意义(P>0.05)。结论:Lap-TaTME可减少低位直肠癌患者手术出血量,加快术后恢复,优化肛门功能,降低手术中转率。

Objective:To observe the application effect of laparoscopic transanal total mesorectal excision(Lap-taTME)in low rectal cancer patients undergoing anal sphincter preservation surgery.Method:Fifty patients with low rectal cancer who intended to undergo anal preservation surgery were selected from Dehua County Hospital from January 2022 to February 2024.According to the method of random number table,they were divided into control group and study group,25 cases in each group.The control group was given total mesorectal excision(TME)and the study group was given Lap-TaTME.Perioperative indexes,recovery condition,anal function 3 months after surgery,surgical conversion rate,and short-term poor prognosis of tumors were compared between the two groups.Result:The intraoperative blood loss volume in the study group was less than that in the control group,and the operative time was longer than that in the control group,the differences were statistically significant(P<0.05).Incision healing time and hospital stay in the study group were shorter than those in the control group,and postoperative anal exhaust time and getting out of bed activity time were significantly earlier than those in the control group,the differences were statistically significant(P<0.05).Three months after surgery,the Wexner score of the study group was lower than that of the control group,and the difference was statistically significant(P<0.05).The conversion rate of surgery in the study group was 8.00%(2/25),which was lower than 36.00%(9/25)in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of short-term adverse prognosis between the two groups(P>0.05).Conclusion:Lap-TaTME can reduce the amount of surgical bleeding in patients with low rectal cancer,accelerate postoperative recovery,optimize anal function,and reduce the rate of surgical conversion.