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中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 46 -49. doi: 10.3877/cma.j.issn.1674-3946.2020.01.015

所属专题: 文献

论著

腹腔镜下改良Bacon’s直肠癌根治术对患者术后肛门功能与远期疗效观察
刘李1, 杨烈2,(), 杨柳1, 贺玉华2   
  1. 1. 641300 四川大学华西医院资阳医院
    2. 610041 四川大学华西医院
  • 收稿日期:2019-02-26 出版日期:2020-02-26
  • 通信作者: 杨烈

Long-term outcome and postoperative anal function after laparoscopic modified Bacon’s radical resection of rectal cancer

Li Liu1, Lie Yang2,(), Liu Yang1, Yuhua He2   

  1. 1. Ziyang Hospital, West China Hospital, Sichuan University, Sichuan 641300, China
    2. West China Hospital Sichuan University, Sichuan 610041, China
  • Received:2019-02-26 Published:2020-02-26
  • Corresponding author: Lie Yang
  • About author:
    Corresponding author: Yang Lie, Email:
  • Supported by:
    2018 Planing Program of Sichuan Health and Planning Commission(No.18PJ247)
引用本文:

刘李, 杨烈, 杨柳, 贺玉华. 腹腔镜下改良Bacon’s直肠癌根治术对患者术后肛门功能与远期疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2020, 14(01): 46-49.

Li Liu, Lie Yang, Liu Yang, Yuhua He. Long-term outcome and postoperative anal function after laparoscopic modified Bacon’s radical resection of rectal cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(01): 46-49.

目的

探讨腹腔镜下改良Bacon’s直肠癌根治术对低位直肠癌患者术后肛门功能及远期疗效的影响。

方法

回顾性分析2012年1月至2013年10月收治的低位直肠癌患者63例,按术式分组,其中30例行改良Bacon’s直肠癌根治术患者为A组,33例行腹腔镜下双吻合器术直肠前切除术患者为B组。采用SPSS20.0软件进行统计学分析。术后排便能力、并发症发生率采用χ2检验;术中术后各项指标以(±s)描述,独立样本t检验;累积生存率比较应用LogRank检验,均采用双侧检验,P<0.05差异有统计学意义。

结果

两组术中失血量、手术时间、淋巴结清扫数量、术后3个月及12个月时排便能力、并发症发生率及住院时间比较差异无统计学意义(P>0.05),但A组术后肠功能恢复时间较B组短(P<0.05);术后6个月时排便优良率显著优于B组(χ2=4.237,P=0.039),住院费用显著低于B组(t=8.290, P=0.000);经Kaplan-Meier生存分析显示,两组累积生存率分别为83.3%、84.8%,差异无统计学意义(χ2=0.001,P=0.969)。

结论

低位直肠癌患者腹腔镜下行改良Bacon’s直肠癌根治术或行双吻合器术直肠前切除术,在并发症、生存率上无明显差异,但前者术后肠道功能恢复及排除能力改善更显著,值得临床重视。

Objective

To observe the long-term outcome and postoperative anal function after laparoscopic modified Bacon’s radical resection of rectal cancer.

Methods

A retrospective analysis was performed in 63 patients with low rectal cancer from January 2012 to October 2013, who were divided into groups according to surgical methods. Among them, 30 patients receiving modified Bacon’s radical resection of rectal cancer were in group A, and 33 patients receiving laparoscopic double-stapler prerectal resection were in group B. Statistical analysis were performed by using SPSS20.0 software. Measurement data, such as perioperative indicators and nutrition status were expressed as (±s), and were examined by independent test. Count data such as anal function and postoperative complications were examined by chi square test. Cumulative survival were examined by Log-Rank test. A P value <0.05 was considered as statistically significant difference.

Results

There was no significant difference in the amount of blood loss, operation time, number of harvested lymph nodes, defecation ability on 3 months and 12 months after operation, as well as incidence of complication and hospitalization stay between two groups (P>0.05). The postoperative recovery time of intestinal function in group A was shorter than that in group B (P<0.05). The excellent rate of defecation was significantly better than that in group B at 6 months after operation (χ2=4.237, P=0.039). The hospitalization cost was significantly lower than that in group B (t= 8.290, P=0.000). Kaplan-Meier survival analysis showed that the cumulative survival of the two groups were 83.3% and 84.8% respectively (χ2=0.002, P=0.969).

Conclusion

There were no significant difference in complications and survival rate of patients with low rectal cancer undergo laparoscopic modified Bacon’s radical operation of rectal cancer or double stapling technique anterior resection of rectum. However, the improvement of intestinal function recovery and elimination ability of the former after operation is more significantly, which deserves clinical attention.

表1 63例低位直肠癌患者不同术式两组一般资料比较[(±s),例]
表2 63例低位直肠癌患者不同术式两组患者一般手术情况比较(±s)
表3 63例低位直肠癌患者不同术式两组并发症发生率比较(例)
表4 63例低位直肠癌患者不同术式两组术后排便能力比较(例)
图1 63例低位直肠癌患者不同术式两组术后5年Kaplan-Meier生存分析(月)
[1]
刘德洪,黄江平.低位直肠癌Dixon保肛手术联合预防性回肠造口的应用效果观察[J/CD].中华普外科手术学杂志(电子版),2018,12(3):254-257.
[2]
Park EJ, Cho MS, Baek SJ,et al.Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery[J].Ann Surg,2015,261(1):129-137.
[3]
Biondo S, Trenti L, Galvez A,et al.Two-stage Turnbull-Cutait pull-through coloanal anastomosis versus coloanal anastomosis with protective loop ileostomy for low rectal cancer. Protocol for a randomized controlled trial (Turnbull-BCN)[J].Int J Colorectal Dis, 2017,32(9):1357-1362.
[4]
Uemura M, Ikeda M, Kawai K,et al.Laparoscopic surgery using a Gigli wire saw for locally recurrent rectal cancer with concomitant intraperitoneal sacrectomy[J].Asian J Endosc Surg,2018,11(1):83-86.
[5]
汪建平.低位直肠癌术式选择及评价[J].中国实用外科杂志,2017,37(6):593-595.
[6]
张永康,张剑,廖晓锋.腹腔镜下直肠经肛门拖出式手术与直肠前切除术治疗低位直肠癌的比较[J].中国微创外科杂志,2016,16(8):736-739.
[7]
池畔,陈致奋.低位直肠癌的腹腔镜手术--内括约肌切除术、Miles手术还是肛提肌外腹会阴联合直肠切除术[J].中华胃肠外科杂志,2015,18(8):750-754.
[8]
蔡鹏,刘浩,王凯,等.折刀位腹腔镜Miles术与截石位腹腔镜Miles术治疗低位直肠癌效果比较[J].山东医药,2018,58(9):61-63.
[9]
赵泽峰,杨之斌.经肛门拖出式全腔镜直肠前切除术治疗中低位直肠癌效果观察[J].山东医药,2017,57(34):53-55.
[10]
楼征,何建,朱晓明,等.经肛门拖出式适形切除术治疗极低位直肠癌的临床研究[J].中华胃肠外科杂志,2015,18(1):69-71.
[11]
周宗进,吴安定,金朝霞,等.腹腔镜下低位直肠癌改良Bacon术临床应用分析[J].临床外科杂志,2017,25(1):67-69.
[12]
谢军,张文利.弧形切割闭合器应用于中低位直肠癌保肛术的临床效果[J].实用癌症杂志,2017,32(2):239-241.
[13]
何泽民.低位直肠癌保肛手术术式选择[J].中国继续医学教育,2017,9(3):78-79.
[14]
周海涛,周志祥,梁建伟,等.无切口腹腔镜下直肠外翻技术的直肠癌低位前切除术的近期疗效[J].中华肿瘤杂志,2015, 37(1):63-66.
[15]
张宏,凌云志,崔明明,等.外翻脱出式切除术在腹腔镜直肠癌超低前切除术中的应用[J]. 中华消化外科杂志,2015,14(11):957-962.
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