摘要
目的:探讨腹腔镜辅助经肛门全直肠系膜切除术(Ta-TME)治疗直肠癌的有效性及安全性。方法:分析2016年7月至2019年6月手术治疗的83例中低位直肠癌患者的临床资料,将其随机分为腹腔镜辅助Ta-TME组(Ta-TME组,n=40)与传统腹腔镜组(传统组,n=43)。对比分析两组围手术期及随访结果。结果:两组患者一般资料差异无统计学意义。Ta-TME组下床时间[(36.8±7.0)h vs.(43.0±9.6)h,t=1.110,P=0.002]早于传统组,术后镇痛药使用率[17.5%vs.37.2%,χ~2=4.019,P=0.045]低于传统组,住院总费用[(49256.0±1343.8)元vs.(52056.8±1685.9)元,t=1866.626,P<0.001]少于传统组。两组吻合口漏、术后出血、肠梗阻、切口感染差异无统计学意义,两组均无直肠远端切缘阳性病例,淋巴结检出数量差异无统计学意义。术后随访0~36个月,复发转移2例(Ta-TME组1例,传统组1例),死亡1例(Ta-TME组)。结论:Ta-TME治疗中低位直肠癌安全、有效。
Objective:To study the efficacy and safety of laparoscopic assisted transanal total mesorectal excision(Ta-TME)in the treatment of middle and lower rectal cancer.Methods:The clinical data of the patients with middle and lower rectal cancer who underwent surgery from Jul.2016 to Jun.2019 was analyzed.Eighty-three patients were enrolled and randomly divided into laparoscopically assisted Ta-TME group(n=40)and traditional group(n=43).The perioperative and follow-up results between the two groups were compared.Results:There was no significant difference in baseline parameter between the two groups.In the aspect of postoperative recovery,the time of getting out of bed after operation was significantly earlier in the Ta-TME group than those in the traditional group([36.8±7.0)h vs.(43.0±9.6)h,t=1.110,P=0.002].The Ta-TME group was significantly less in using postoperative analgesic than the traditional group[17.5%(7/40)vs 37.2%(16/43),χ~2=4.019,P=0.045],the total hospitalization cost was significantly lower in the Ta-TME group than in the traditional group[(49256.0±1343.8)yuan vs.(52056.8±1685.9)yuan,t=1866.626,P<0.001].In aspect of postoperative complications,there were no significant differences between the two groups including anastomotic leakage,postoperative bleeding,intestinal obstruction,and incision infection.There was no positive distal rectal margin in both groups.No significant difference was found in the circumferential margin and in the number of lymph node resected of the two groups.The patients were followed up for 0 to 36 months.There were 2 cases of recurrence and metastasis(1 in the Ta-TME group,1 in the traditional group)and 1 death(Ta-TME group).Conclusions:Laparoscopically assisted Ta-TME for the treatment of middle and lower rectal cancer is safe and effective.
作者
李由
冷蔚
吴红
曹万龙
李蜀华
LI You;LENG Wei;WU Hong(Department of General Surgery,the First People's Hospital of Zigong,Zigong 643000,China)
出处
《腹腔镜外科杂志》
2020年第1期54-58,共5页
Journal of Laparoscopic Surgery
基金
四川省医学会青年课题(Q16089)
关键词
直肠肿瘤
腹腔镜检查
全直肠系膜切除术
疗效比较研究
Rectal neoplasms
Laparoscopy
Total mesorectal excision
Comparative effectiveness research
