研究两种直肠全系膜切除术(TME)对超低位直肠癌患者的治疗疗效和安全性的影响。

选择2013年6月至2016年1月治疗的超低位直肠癌患者84例。根据患者治疗方案分为腹腔镜TME组和经肛直肠全系膜切除术(TaTME)组，各42例。两组患者治疗后随访1年，应用SPSS20.0进行数据分析，围手术期指标、PAC－QOL评分比较采用计量资料用(±s)表示，组间比较采用独立t检验；并发症发生率、死亡率、复发率、转移率计数资料用%表示，采用χ²检验，以P<0.05为差异有统计学意义。

两组患者在术后镇痛时间、留置尿管时间、淋巴结清扫数目等方面差异无统计学意义(P>0.05)，TaTME组在手术时间大于腹腔镜TME组，术中出血量、住院时间、肛门排气时间低于腹腔镜TME组，差异有统计学意义(P<0.05)。两组患者在并发症发生率及死亡率比较差异无意义(P>0.05); TaTME组患者PAC－QOL评分为(36.8±3.0)分，低于腹腔镜TME组患者的(40.4±3.7)分，差异有统计学意义(P<0.05)。腹腔镜TME组患者术后1年生存率为90.5%，低于TaTME组患者的生存率95.2%，差异无统计学意义(P>0.05)，两组患者在局部复发、远处转移差异无统计学意义(P>0.05)。

经肛直肠全系膜切除术与腹腔镜直肠全系膜切除术相比，在改善患者生存质量、缩短患者住院时间、术中出血量上具有优势，并发症发生、复发、转移、死亡情况无明显差异。

To investigate the efficacy and safety of two kinds of total mesorectal excision in patients with ultra-low rectal cancer.

From June 2013 to January 2016, 84 patients with ultra-low rectal cancer treated in our hospital were retrospectively analyzed. The patients were divided into the laparoscopic TME group and the transanal total mesorectal excision (TaTME) group, each with 42 cases. After treatment, the two groups of patients were followed up for 1 year. The SPSS20.0 was used to analysis the data, perioperative index, PAC-QOL score were showed as (±s) and compared with independent t test; the incidence of complications, mortality, recurrence rate, metastasis rate were compared with χ² test. P<0.05 meant the difference was statistically significant.

There was no significant difference in the postoperative analgesia time, indwelling catheter time and the number of lymph node between two group (P>0.05). The operation time of group TaTME was longer than that of laparoscopic TME group, the amount of bleeding, hospitalization time, anal exhaust time was lower than that of laparoscopic TME group, the difference was statistically significant (P<0.05). The incidence of complications and mortality were not significant between the two groups (P>0.05); The TaTME group had PAC-QOL (36.8±3.0), which was lower than the laparoscopic group (40.4±3.7), the difference was statistically significant (P<0.05). Laparoscopic surgery in TME group after 1 year survival rate was 90.5%, which was lower than the patients in the TaTME group survival rate was 95.2%, but the difference was not statistically significant (P>0.05), there was no significant difference in local recurrence and distant metastasis between the two groups (P>0.05).

Compared with laparoscopic total mesorectal excision, transanal total mesorectal excision has advantages in improving the quality of life, shortening the length of stay, and reducing the amount of bleeding during operation. There is no significant differences in incidence rate of complications, recurrence, metastasis and death.