摘要
目的探讨腹腔镜改良柱状切除术治疗中低位直肠癌的临床效果。方法回顾性分析2015年2月至2016年6月在苏州大学附属第二医院胃肠外科及南京医科大学附属江苏盛泽医院普外科收治的98例中低位直肠癌患者临床资料,其中44例行腹腔镜传统Miles术(对照组),54例行腹腔镜下经腹会阴联合改良柱状切除术(观察组)。比较两组手术相关指标及术后情况。结果两组手术时间、术后进食时间、拔除引流管时间、住院时间比较,差异均无统计学意义(均P>0.05);观察组留置导尿管时间长于对照组,差异有统计学意义(P<0.05)。两组术后尿潴留、切口感染发生率比较,差异均无统计学意义(均P>0.05),观察组术中穿孔率、术后性功能障碍发生率、并发症总发生率及标本CRM阳性率低于对照组,差异均有统计学意义(均P<0.05)。患者随访8~30个月,中位随访时间为10个月,两组术后局部复发率比较差异无统计学意义(P>0.05)。结论腹腔镜改良柱状切除术治疗中低位直肠癌较腹腔镜传统Miles术有着更高的手术安全性以及更低的CRM阳性率,有助于减少术后并发症发生,具有较高的临床应用价值。
Objectives To investigate the application of laparoscopic modified cylindrical abdominal-perineal resection for mid and low rectal cancer.Methods This was a retrospective analysis of 98 patients with mid and low rectal cancer treated at the Department of Gastrointestinal Surgery,the Second Affiliated Hospital of Soochow University,and the Department of General Sur?gery,the Affiliated Jiangsu Shengze Hospital of Nanjing Medical University between February 2015 and June 2016.Forty-four pa?tients received laparoscopic conventional Miles operation(control group),and 54 received laparoscopic modified cylindrical abdomi?nal-perineal resection(treatment group).Surgical parameters and postoperative recovery were compared between the two groups.Results Duration of surgery,time to postoperative oral intake,timing of drain removal,and duration of hospitalization did not differ significantly between groups(P>0.05).Patients in the treatment group had a significantly longer time to Foley catheter re?moval(P<0.05).The two groups did not differ in the incidence of postoperative urinary retention and incision infection(P>0.05).The treatment group had a significantly lower incidence of intraoperative perforation,postoperative sexual dysfunction,overall com?plications,and rate of positive circumferential resection margin(P<0.05).Patients were followed up for 8 to 30 months with a me?dian of 10 months,and the rate of local recurrence was comparable between groups(P>0.05).Conclusion Compared with con?ventional Miles operation,laparoscopic modified cylindrical abdominal-perineal resection was safer and had a lower rate of posi?tive circumferential resection margin for patients with mid and low rectal cancer.It could lower the risk of postoperative compli?cations and be potentially valuable for clinical application.
作者
胡明超
顾建春
许华
杨晓东
俞文渊
袁雄
赵奎
刘利峰
Hu Mingchao;Gu Jianchun;Xu Hua;Yang Xiaodong;Yu Wenyuan;Yuan Xiong;Zhao Kui;Liu Lifeng(Department of General Surgery,The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University,Suzhou 215228,Jiang?su,China;Department of Gastrointestinal Surgery,The Second Affiliated Hospital of Soochow University,Suzhou 215200,Jiangsu,China)
出处
《结直肠肛门外科》
2020年第2期183-187,共5页
Journal of Colorectal & Anal Surgery
基金
苏州市临床医学专家团队引进项目(SZYJTD201726)
苏州市民生科技指导项目(SYSD2017043)
江苏省苏州市吴江区科教兴卫项目(wwk201712)。
关键词
中低位直肠癌
腹腔镜手术
改良柱状切除术
mid and low rectal cancer
laparoscopic surgery
modified cylindrical abdominal-perineal resection
