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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (04) : 396 -399. doi: 10.3877/cma.j.issn.1674-3946.2019.04.024

所属专题： 文献；

论著

腹腔镜经肛拖出根治术与传统开腹切除术治疗中低位直肠癌的临床比较
王清奎1, 吉丙阳1,†()   
  1. 1. 710043　陕西省第四人民医院肛肠科
  • 收稿日期:2018-08-23 出版日期:2019-08-26
  • 通信作者: 吉丙阳

Clinical comparison of laparoscopic and transanal pull-through radical surgery and conventional open surgery for the treatment of mid-low rectal cancer

Qinkui Wang1, Bingyang Ji1,†()   

  1. 1. Department of anal bowel, fourth people’s hospital of Shaanxi province 710443
  • Received:2018-08-23 Published:2019-08-26
  • Corresponding author: Bingyang Ji
  • About author:
    Corresponding autho: Ji Bingyang, Email:
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引用本文：

王清奎, 吉丙阳. 腹腔镜经肛拖出根治术与传统开腹切除术治疗中低位直肠癌的临床比较[J]. 中华普外科手术学杂志(电子版), 2019, 13(04): 396-399.

Qinkui Wang, Bingyang Ji. Clinical comparison of laparoscopic and transanal pull-through radical surgery and conventional open surgery for the treatment of mid-low rectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(04): 396-399.

目的

比较腹腔镜经肛拖出根治术与传统开腹切除术治疗中低位直肠癌的临床疗效。

方法

回顾性分析2014年6月至2018年4月103例中低位直肠癌患者的临床资料，根据手术方法不同分为研究组和开腹组，其中研究组患者49例，采用腹腔镜经肛拖出根治术；开腹组54例，采用传统开腹治疗。数据处理应用统计学软件SPSS22.0完成。本研究中并发症发生率、临床有效率分析采用四格表χ2检验；手术相关指标以(±s)表示，采用独立t检验；P<0.05为差异存在统计学意义。

结果

两组患者手术时间和淋巴结清扫数目差异无统计学意义(均P>0.05)，研究组术中出血量、肠道功能恢复时间及住院时间明显低于开腹组患者(均P<0.05)；研究组并发症发生率为8.2%，开腹组并发症发生率为11.1%，差异无统计学意义(P>0.05)；研究组患者治疗有效率为95.9%明显高于开腹组83.3%(P<0.05)，差异有统计学意义。

结论

与传统开腹切除术治疗中低位直肠癌的比较，腹腔镜经肛拖出根治术具有治疗效率高、出血少、肠道功能恢复快及住院时间短等优点，值得推广应用。

关键词: 直肠肿瘤, 腹腔镜检查, 剖腹术, 治疗结果
Objective

To compare clinical efficacy of laparoscopic and transanal pull-through radical surgery y and conventional open surgery for the treatment of mid-low rectal cancer.

Methods

The clinical data of 103 patients with middle and lower rectal cancer treated in our hospital from June 2014 to April 2018 were retrospectively analyzed. According to the different surgical methods, they were divided into study group and control group, among them, 49 patients in the study group were treated with laparoscopic and transanal pull-through radical surgery, and 54 patients in the study group were treated with conventional open surgery. The relevant indicators of surgery, the incidence of complications and the efficiency of clinical treatment between the two groups were compared, among them, the independent sample t-test was used to compare the relevant indicators of surgery, Chi-square test was used to compare the incidence of complications and the efficiency of clinical treatment.

Results

There was no significant difference in the operation time and the number of lymph node dissection between the two groups (all P>0.05), the blood loss, intestinal function recovery time and hospitalization time in the study group were significantly lower than those in the control group (all P<0.05). The incidence of complications was 8.2% in the study group and 11.1% in the control group, there was no significant difference between the two groups (P>0.05). The treatment effective rate was 95.9% in the study group and 83.3% in the control group, the treatment effective rate of the study group was significantly higher than that of the control group (P>0.05).

Conclusion

Compared with traditional open surgery for the treatment of middle and lower rectal cancer, laparoscopic and transanal pull-through radical surgery has the advantages of higher treatment efficiency, less bleeding, rapider recovery of intestinal function and shorter hospitalization time, it is worthy of popularization and application.

Key words: Rectal neoplasms, Laparoscopy, Laparotomy, Treatment outcome
表1 103例中低位直肠癌患者不同术式两组患者基本资料比较(±s)
组别 例数 年龄(岁) 性别(例) 肿瘤直径(cm) 肿瘤分期(例)
男/女 Ⅰ期/Ⅱ期
研究组 49 53.6±10.7 30/19 3.1±0.6 12/37
开腹组 54 55.4±12.3 32/22 2.9±0.8 13/41
t/χ2 ? －0.788 0.838 1.423 0.960
P ? >0.05 >0.05 >0.05 >0.05
表2 103例中低位直肠癌患者不同术式两组患者术中术后指标比较(±s)
组别 手术时间(min) 术中出血量(ml) 肠道功能恢复(d) 住院时间(d) 清扫淋巴结数目(个)
研究组 148.4±42.2 131.6±25.2 129.2±50.5 12.4±2.5 12.3±2.4
开腹组 134.6±37.8 189.3±44.1 170.3±65.4 17.3±2.1 11.2±3.6
t值 1.7507 －8.0423 －3.5433 －10.8037 1.8052
P值 >0.05 <0.05 <0.05 <0.05 >0.05
表3 103例中低位直肠癌患者不同术式两组患者术后并发症发生率的比较[例(%)]
组别 例数 吻合口狭窄 吻合口漏 大便失禁 总发生率
研究组 49 1(2.0) 3(6.1) 0(0) 4(8.2)
开腹组 54 1(1.9) 4(7.4) 1(1.9) 6(11.1)
χ2值 ? ? ? ? 0.6138
P值 ? ? ? ? >0.05
表4 103例中低位直肠癌患者不同术式两组患者临床有效率比较[例(%)]
组别 例数 痊愈 有效 无效 有效率
研究组 49 36(73.5) 11(22.4) 2(4.1) 47(95.9)
开腹组 54 16(29.6) 29(53.7) 9(16.7) 45(83.3)
χ2值 ? ? ? ? 4.2651
P值 ? ? ? ? <0.05
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