腹腔镜联合经肛门括约肌间超低位直肠癌切除术:附68例报告
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任学群, Email: hhyyrxq@126.com

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河南大学自然科学基金资助项目(2013YBZR034)。


Laparoscopic-assisted intersphincteric resection for ultra-low rectal cancer: a report of 68 cases
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    摘要:

    目的:探讨腹腔镜联合经肛门括约肌间径路超低位直肠癌切除的可行性。方法:回顾2010年1月—2012年6月68例行腹腔镜经肛门括约肌间径路超低位直肠癌根治术患者(腔镜组)与同期行76例开腹经肛门括约肌间径超低位直肠癌根治术患者(开腹组)的临床资料,比较两组临床指标与疗效。结果:144例手术均获成功,腔镜组无中转开腹。与开腹组比较,腔镜组手术时间延长[(243.7± 40.4)min vs.(150.5±32.1)min],但术中出血量减少[(103.2±10.5)mL vs.(231.6±23.5)mL]、术后切口感染例数减少(1例 vs. 8例)、肛门排气时间缩短[(2.5±0.6)d vs.(4.6±0.5)d]、住院天数减少[(10.5±0.4)d vs.(14.6±0.3)d],差异均有统计学意义(均P<0.05);两组扫淋巴结数目、吻合口瘘与肠梗阻发生例数,以及术后1年生存率差异均无统计学意义(均P>0.05)。结论:腹腔镜应用于经肛门括约肌间径路超低位直肠癌手术安全可行,并有微创、术后切口感染少等优点。

    Abstract:

    Objective: To evaluate the feasibility of laparoscopic-assisted intersphincteric resection for ultra-low rectal cancer. Methods: The clinical data of 68 patients undergoing laparoscopic-assisted intersphincteric resection for ultra-low rectal cancer (laparoscopic group) between January 2010 and June 2012, along with 76 patients undergoing open intersphincteric resection for ultra-low rectal cancer (open surgery group) during the same period were retrospectively studied. The clinical parameters and efficacies between the two groups were compared. Results: Operations were successfully performed in all the 144 patients, and no open conversion was required in laparoscopic group. In laparoscopic group compared with open surgery group, the operative time was prolonged [(243.7±40.4) min vs. (150.5±32.1) min], but the intraoperative blood loss [(103.2±10.5) mL vs. (231.6±23.5) mL], number of cases with postoperative incision infection ( 1 vs. 8), time to flatus [(2.5±0.6) d vs. (4.6±0.5) d], and length of hospital stay [(10.5±0.4) d vs. (14.6±0.3) d] were all decreased, and all the differences had statistical significance (all P<0.05); the difference in number of resected lymph nodes, and number of cases who developed anastomotic fistula or intestinal obstruction, as well as the 1-year postoperative survival between the two groups had no statistical significance (all P>0.05). Conclusion: Laparoscopic-assisted intersphincteric resection for ultra-low rectal cancer is safe and efficient, and it also offers advantages such as minimal invasiveness and reduced postoperative incision infection.

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李全营,秦长江,孙嵩洛,任学群.腹腔镜联合经肛门括约肌间超低位直肠癌切除术:附68例报告[J].中国普通外科杂志,2014,23(4):447-450.
DOI:10.7659/j. issn.1005-6947.2014.04.009

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  • 收稿日期:2013-12-27
  • 最后修改日期:2014-03-21
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  • 在线发布日期: 2014-04-15