| 张涵朔,任镜清,朱伟聪,杨小红,刘少杰.手辅助腹腔镜在肛门全直肠系膜切除术治疗中低位直肠癌中的应用价值[J].,2021,(6):1169-1173 |
| 手辅助腹腔镜在肛门全直肠系膜切除术治疗中低位直肠癌中的应用价值 |
| Application Value of Hand Assisted Laparoscopic Surgery in the Treatment of Middle and Low Rectal Cancer with Transanal Total Mesorectal Excision |
| 投稿时间：2020-09-06 修订日期：2020-09-30 |
| DOI：10.13241/j.cnki.pmb.2021.06.038 |
| 中文关键词: 中低位直肠癌 手辅助腹腔镜 应用价值 肛门全直肠系膜切除术 |
| 英文关键词: Middle and low rectal cancer Hand assisted laparoscopic Application value Transanal total mesorectal excision |
| 基金项目:广东省科技计划项目（2016A050503003） |
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| 中文摘要: |
| 摘要 目的：探讨手辅助腹腔镜在肛门全直肠系膜切除术（TaTME）治疗中低位直肠癌中的应用价值。方法：选取2014年5月至2016年9月期间在广州市红十字会医院接受TaTME术治疗的中低位直肠癌患者130例为研究对象，根据数字表法将其随机分为研究组和对照组，其中研究组（60例）患者行手辅助腹腔镜下TaTME术治疗，对照组（70例）行腹腔镜下TaTME术治疗。比较两组手术时间、淋巴结清扫数目、术中出血量、保肛率、住院时间、切口愈合时间、首次下床活动时间，并比较两组术后并发症发生率、远期复发率及死亡率。结果：研究组术中出血量、手术时间较对照组减少（P＜0.05），而保肛率、淋巴结清扫数目两组比较无差异（P>0.05）。研究组首次下床活动时间、切口愈合时间较对照组缩短（P＜0.05），而术后住院时间两组比较无差异（P>0.05）。研究组术后出现切口感染、吻合口瘘、尿道感染、盆腔脓肿及肠梗阻等并发症发生率为3.33%（2/60），少于对照组的10.00 %（7/70），但两组比较无差异（P>0.05）。术后4年内，研究组总复发率和总死亡率与对照组比较，差异均无统计学意义（P>0.05）。结论：中低位直肠癌患者行TaTME术治疗，运用手辅助腹腔镜可明显缩短手术时间，减少术中出血，尽快促进切口愈合，且术后并发症发生率、远期复发率及死亡率较低，实用性高，值得推广应用。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the application value of hand assisted laparoscopic in the treatment of middle and low rectal cancerwith transanal total mesorectal excision (TaTME). Methods: From May 2014 to September 2016, 130 patients with middle and low rectal cancer who received TaTME operation in guangzhou red cross hospital were selected as the study objects, they were randomly divided into study Guangzhou Red Cross Hospital according to the number table method, among them, the study group (60 patients) were treated by hand assisted laparoscopic TaTME, and the control group (70 patients) were treated by laparoscopic TaTME. The operation time, number of lymph node dissection, intraoperative bleeding volume, anal preservation rate, hospitalization time, incision healing time, first time out of bed activity were compared between the two groups, and the incidence rate of postoperative complications, long-term recurrence rate and mortality rate of the two groups were compared. Results: The intraoperative bleeding volume, operation time in the study group were less than those in control group (P<0.05). There were no significant differences between the two groups in the number of anal preservation rate and lymph node dissection (P>0.05). The first time out of bed activity, incision healing time in study group were significantly shorter than those in control group (P<0.05), while there was no significant difference between the two groups in the postoperative hospitalization time (P>0.05). The incidence rate of postoperative complications such as incision infection, anastomotic leakage, urinary tract infection, pelvic abscess and intestinal obstruction was 3.33% (2/60), which was less than 10.00% (7/70) in the control group, but there was no significant difference between the two groups (P>0.05). There were no significant differences in the total recurrence rate and total mortality rate between the study group and the control group within 4 years after operation (P>0.05). Conclusion: In the treatment of middle and low rectal cancer patients with TaTME, the use of hand assisted laparoscopic surgery can significantly shorten the operation time, reduce intraoperative bleeding, promote incision healing as soon as possible, and the incidence rete of postoperative complications, long-term recurrence rate and mortality rate are low, it has high practicability, and it is worthy of popularization and application. |
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