手助腹腔镜手术联合全腔镜手术治疗低位局部进展期直肠癌的效果观察

Observation on the Efficacy of Hand-Assisted Laparoscopic Surgery Combined with Total Laparoscopic Surgery for the Treatment of Low-Lying Locally Advanced Rectal Cancer

目的 探讨手助腹腔镜手术(HALS)联合全腔镜手术(LAP)治疗低位局部进展期直肠癌的效果,以防止延误治疗、减少术后并发症发生。方法 选取2022年12月至2024年1月收治的低位局部进展期直肠癌患者198例,按照随机数字表法分为HALS组、LAP组及联合组各66例。LAP组行LAP治疗,HALS组行HALS治疗,联合组行LAP联合HALS治疗。比较3组术中出血量、清扫淋巴结数量、手术时间、术后肛门排气时间、下床活动时间及住院时间,术前及术后1、3、7 d C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、淀粉样蛋白A(SAA)水平,术前、术后3个月直肠肛管抑制反射阈值(AIRT)、最大耐受容量(MTV)、肛管最大收缩压(MSP)、肛管静息压(ARP)、直肠静息压(RRP),以及术后并发症发生率。结果 联合组术中出血量、手术时间、术后肛门排气时间、下床活动时间及住院时间少于或短于HALS组、LAP组,HALS组少于或短于LAP组(P<0.05)。联合组术后1、3、7 d血清CRP、TNF-α、IL-6、SAA水平低于HALS组、LAP组,HALS组低于LAP组(P<0.05)。联合组术后3个月MSP、ARP、MTV高于HALS组、LAP组,HALS组高于LAP组,RRP、AIRT低于HALS组、LAP组,HALS组低于LAP组(P<0.05)。联合组术后并发症总发生率低于LAP组(P<0.05)。结论 HALS联合LAP治疗低位局部进展期直肠癌创伤小,术后恢复快,并可有效改善肛肠功能、减少术后并发症发生,避免延误治疗。

Objective To explore the efficacy of hand-assisted laparoscopic surgery(HALS)combined with total laparoscopic surgery(LAP)in the treatment of low-lying locally advanced rectal cancer,so as to prevent delayed treatment and reduce postoperative complications.Methods A total of 198 patients with low-lying locally advanced rectal cancer admitted from December 2022 to January 2024 were selected and randomly divided into three groups:the HALS group,the LAP group,and the combination group,with 66 patients in each group.The LAP group,the HALS group and the combination group underwent LAP,HALS,and LAP combined with HALS,respectively.The intraoperative blood loss,number of lymph nodes dissected,duration of operation,postoperative anal exhaust time,time to ambulation,and length of hospital stay were compared among the three groups.C reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and serum amyloid A(SAA)levels were compared before surgery,and at 1,3,and 7 d after surgery.Rectal anal inhibitory reflex threshold(AIRT),maximum tolerated volume(MTV),maximum anal squeeze pressure(MSP),anal resting pressure(ARP),rectal resting pressure(RRP),and postoperative complication rate were also compared before surgery and at 3 months after surgery.Results The intraoperative blood loss,duration of operation,postoperative anal exhaust time,time to ambulation,and length of hospital stay in the combination group were less or shorter than those in the HALS group and LAP group,with the HALS group being less or shorter than the LAP group(P<0.05).Serum levels of CRP,TNF-α,IL-6,and SAA at 1,3,and 7 d after surgery were lower in the combination group than in the HALS group and LAP group,with the HALS group being lower than the LAP group(P<0.05).At 3 months after surgery,MSP,ARP,and MTV were higher in the combination group than in the HALS group and LAP group,with the HALS group being higher than the LAP group.Meanwhile,RRP and AIRT were lower in the combination group than in the HALS group and LAP group,with the HALS group being lower than the LAP group(P<0.05).The total incidence of postoperative complications in the combination group was lower than that in the LAP group(P<0.05).Conclusion HALS combined with LAP for the treatment of low-lying locally advanced rectal cancer has minimal trauma and rapid postoperative recovery,and can effectively improve anorectal function,reduce postoperative complications,and avoid delayed treatment.