目的 对比分析开腹与腹腔镜内外括约肌间切除术(intersphincteric resection,ISR)Ⅱ～Ⅲ期低位直肠癌保肛中的临床疗效。方法 选取普外科治疗的70例Ⅱ～Ⅲ期低位直肠癌保肛患者,随机分为观察组(腹腔镜ISR术)和对照组(开腹ISR术),对比两组术后的临床指标、并发症和转移复发率。结果 观察组术中出血量[(94.68±18.76) mL]、肛门首次排气时间[(1.21±0.36) d]、住院时间[(9.54±1.39) d]均显著优于对照组[(203.22±35.18) mL、(2.18±0.67)d、(12.73±1.52)d,P＜0.05],而手术时间、术中淋巴结清扫数等差异无统计学意义。术后并发症(11.4%)、转移复发(5.7%)也明显低于对照组(37.1%、22.9%,P＜0.05)。结论 相较于开腹ISR手术,腹腔镜ISR手术具有较高的临床疗效,较低的术后并发症和转移复发率,值得临床推广。
Objective To analyze and compare the clinical effects of laparotomy and laparoscopic intersphincteric resection (ISR) in the preservation of rectal cancer at stage Ⅱ-Ⅲ.Methods A total of 70 patients with stage Ⅱ-Ⅲ low rectal cancer were selected from Department of General Surgery and randomly divided into an observational group (laparotomy ISR) and a control group (laparoscopic ISR).The clinical indicators,incidence rate of postoperative complications,and recurrence rate between the two groups were compared.Results The observation group showed significantly less intraoperative blood loss volume[(94.68±18.76) mL vs.(203.22±35.18) mL],shorter first anal exsufflation time[(1.21±0.36) d vs.(2.18±0.67) d],and shorter hospital stay[(9.54±1.39) d vs.(12.73±1.52) d] than the control group (P<0.05),but no differences in operation time and the number of lymph node dissection were observed.The incidence rate of postoperative complications (11.43% vs.37.14%) and recurrence rate (5.71% vs.22.86%) in the observation group were also significantly lower than those of the control group (P<0.05).Conclusion Compared with laparotomy ISR,laparoscopic ISR has a better clinical therapeutic effect and lower postoperative complication rate and recurrence rate;therefore,it is worthy of clinical application.
[1] 郭永锋,张洪伟,李祎龙,等.两种内外括约肌间切除术术式对ⅡⅢ期低位直肠癌保肛患者围手术期临床指标随访生存率及并发症的影响[J].山西医药杂志,2017,46(5):585-587.
[2] Jafarian AH,Kermani AT,Esmaeili J.The role of COX-2 and Ki-67 over-expression in the prediction of pathologic response of rectal cancer to neoadjuvant chemoradiation therapy[J].Indian J Cancer,2016,53(4):548-551.
[3] 周彤,张广军,刘作良,等.腹腔镜与开腹经括约肌间超低位直肠癌保肛手术的临床对照研究[J].中华胃肠外科杂志,2013,16(6):565-569.
[4] 黄胜辉,池畔,林惠铭,等.腹腔镜与开放经腹括约肌间切除术治疗低位直肠癌的近期疗效比较[J].中华胃肠外科杂志,2016,19(8):923-927.
[5] Sun H,Xu Y,Xu Q,et al.Rectal cancer:Short-term reproducibility of intravoxel incoherent motion parameters in 3.0T magnetic resonance imaging[J].Medicine (Baltimore),2017,96(19):e6866.
[6] Wu Y,Sun X,Qi J,et al.Comparative study of short- and long-term outcomes of laparoscopic-assisted versus open rectal cancer resection during and after the learning curve period[J].Medicine (Baltimore),2017,96(19):e6909.
[7] 甄亚男,肖瑞雪,徐慧荣,等.腹腔镜肛门括约肌间超低位直肠癌根治术与开腹手术疗效的Meta分析[J].国际肿瘤学杂志,2016,43(1):17-22.
[8] 方复,卢国春,毛华辉,等.腹腔镜全系膜切除术联合经肛门内括约肌切除术治疗超低位直肠癌的疗效分析[J].中华全科医学,2017,15(4):724-726.
[9] Lim CH,Lee IS,Jun BY,et al.Incidence and clinical characteristics of gastroenteropancreatic neuroendocrine tumor in Korea:a single-center experience[J].Korean J Intern Med,2017,32(3):452-458.
[10] McDonald AC,Bunker CH,Raman J,et al.Serum carotenoid and retinol levels in African-Caribbean Tobagonian men with high prostate cancer risk in comparison with African-American men[J].Br J Nutr,2017,11(27):1-9.
[11] 张驰,胡祥,张健,等.腹腔镜经肛门括约肌间直肠癌切除术治疗低位直肠癌[J].中华消化外科杂志,2016,15(3):284-289.
[12] 王枭杰,池畔,林惠铭,等.新辅助放化疗对不同高度低位直肠癌保肛率的影响及其预后因素分析[J].中华外科杂志,2016,54(6):419-423.
[13] 章斐然,李威,王怀明,等.腹腔镜全直肠系膜联合经肛门内括约肌切除治疗低位直肠癌的疗效探讨[J].中华普通外科学文献(电子版),2014,8(3):204-208.
[14] Åsli LM,Johannesen TB,Myklebust TÅ,et al.Preoperative chemoradiotherapy for rectal cancer and impact on outcomes—A population-based study[J].Radiother Oncol,2017,5(17):30153-30156.
[15] Wexner SD,Berho ME.The rationale for and reality of the new national accreditation program for rectal cancer[J].Dis Colon Rectum,2017,60(6):595-602.
