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中华结直肠疾病电子杂志 ›› 2017, Vol. 06 ›› Issue (01) : 46 -51. doi: 10.3877/cma.j.issn.2095-3224.2017.01.010

所属专题: 文献

论著

腹腔镜下超低位直肠癌术式选择及术后生活质量观察
朱信强1, 张明1, 丁闯1, 孔令永1, 陈焰1, 管文贤2,()   
  1. 1. 223800,南京大学医学院附属鼓楼医院集团宿迁市人民医院普外科
    2. 210000,南京大学医学院附属鼓楼医院普外科
  • 收稿日期:2016-10-19 出版日期:2017-02-25
  • 通信作者: 管文贤

Laparoscopic surgical options for ultralow rectal cancer and observed postoperative quality of life

Xinqiang Zhu1, Ming Zhang1, Chuang Ding1, Lingyong Kong1, Yan Chen1, Wenxian Guan2,()   

  1. 1. Department of General Surgery, Suqian People?s Hospital, Nanjing Drum Tower Hospital Group The Affiliated of Nanjing University Medical School, Suqian 223800, China
    2. Department of General Surgery, Nanjing Drum Tower Hospital The Affiliated of Nanjing University Medical School, Nanjing 210008, China
  • Received:2016-10-19 Published:2017-02-25
  • Corresponding author: Wenxian Guan
  • About author:
    Corresponding author: Guan Wenxian, Email:
引用本文:

朱信强, 张明, 丁闯, 孔令永, 陈焰, 管文贤. 腹腔镜下超低位直肠癌术式选择及术后生活质量观察[J/OL]. 中华结直肠疾病电子杂志, 2017, 06(01): 46-51.

Xinqiang Zhu, Ming Zhang, Chuang Ding, Lingyong Kong, Yan Chen, Wenxian Guan. Laparoscopic surgical options for ultralow rectal cancer and observed postoperative quality of life[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2017, 06(01): 46-51.

目的

探讨腹腔镜下超低位直肠癌的手术方式以及术后生活质量情况。

方法

对2013至2015年间南京鼓楼医院集团宿迁市人民医院普外科收治的超低位直肠癌患者24例,分别采用腹腔镜下腹会阴联合切除术(APR),腹腔镜辅助肛门原位再造术和腹腔镜联合骶尾入路手术3种方式,术后生活质量评价采取Wexner评分和大便生活质量调查问卷。数据之间比较采取非参数检验,其中多组独立样本比较常规采用K-WH检验。

结果

所有患者成功实施手术,术后病理切缘、环周切缘及淋巴结计数符合直肠癌肿瘤安全性指标。Wexner评分,手术术后3月、6月、9月差异有统计学意义(H值分别为6.388,8.246,6.563;P值分别为0.043,0.021,0.044)。大便生活质量调查问卷,术后9个月,3组之间对比差异有统计学意义(H值分别为4.568,6.342,5.479,7.236;P值分别为0.024,0.015,0.047,0.031)。而经骶尾术式组,问卷的各项指标接近正常。

结论

腹腔镜下超低位直肠癌经骶保肛手术是可行的,术后生活质量较其他治疗组明显改善。

Objective

To discuss the laparoscopic surgery procedure of ultra-low rectal cancer and postoperative quality of life.

Methods

24 cases of super low rectal cancer treated by general surgery in Suqian People?s Hospital of Nanjing Drum Tower Hospital from 2013 to 2015 were treated with laparoscopic assisted abdominoperineal nealresection (APR), laparoscopic assisted anal in situ re-laparoscopy combined with sacrococcygeal approach, postoperative quality of life evaluation Wexner score and stool quality of life questionnaire. Data were compared between non-parametric test, in which multiple groups of independent samples are more commonly used K-WH test.

Results

All patients underwent successful operation, and the margins of resection margin, circumcision margin and lymph node count accorded with tumor safety index of rectal cancer. Wexner score showed significant difference between the 3th month, 6th month and 9th month after operation (H=6.388, 8.246, 6.563, P=0.043, 0.021, 0.044). The fecal incontinence quality of life questionnaire in the 9th month after operation, the difference in the three groups was statistically significant (H= 4.568, 6.342, 5.479, 7.236, P=0.024, 0.015, 0.047, 0.031). The sacrococcygeal surgery group, the indicators of the questionnaire close to normal.

Conclusion

Laparoscopic ultra-low rectal cancer surgery is feasible by the sacral anus, postoperative quality of life was improved significantly than other treatment groups.

图4 经肛完成吻合
表1 Wexner评分标准
表2 术后Wexner评分结果(±s,分)
表3 术后9个月生活质量调查计分结果(±s,分)
[1]
郑荣寿,张思维,吴良有, 等. 中国肿瘤登记地区2008年恶性肿瘤发病和死亡分析 [J]. 中国肿瘤, 2012, 21(1): 1-12.
[2]
代珍,郑荣寿,邹小农, 等. 中国结直肠癌发病趋势分析和预测 [J]. 中华预防医学杂志, 2012, 46(7): 598-603.
[3]
盛红光,王永. TME基础上的PANP手术在直肠癌根治术中的应用 [J]. 中国现代普通外科进展, 2012, 15(1): 52-54.
[4]
王毅,卜烨,王天民, 等. 确保切缘阴性的二或三吻合器法在超低位直肠癌保肛术中的应用 [J]. 中国综合临床, 2013, 29(7): 699-700.
[5]
Zedan A, Salah T. Total mesorectal excision for the treatment of rectal cancer [J]. Electron Physician, 2015, 7(8): 1666-1672.
[6]
Chen L, Mao YP, Xie FY, et al. The seventh edition of the UICC/AJCC staging system for nasopharyngeal carcinoma is prognostically useful for patients treated with intensity-modulated radiotherapy from an endemic area in China [J]. Radiotherapy & Oncology, 2012, 104(3): 331-337.
[7]
Ryu Y, Akagi Y, Yagi M, et al. Fecoflowmetric analysis of anorectal motor function in postoperative anal-preserving surgery patients with low rectal cancer comparison with the wexner score and anorectal manometry [J]. Int Surg, 2015, 100(1): 29-37.
[8]
Ogata H, Mimura T, Hanazaki K. Validation study of the Japanese version of the Faecal Incontinence Quality of Life Scale [J]. Colorectal Dis, 2012, 14(2): 194-199.
[9]
汪建平. 低位直肠癌保肛手术的再认识 [J]. 中国普外基础与临床杂志, 2012, 19(6): 577-582.
[10]
Martin ST, Heneghan HM, Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer [J]. Br J Surg, 2012, 99(5): 603-612.
[11]
Dai Y, Jiang JB, Bi DS, et al. Preservation of the continence function after intersphincteric resection using a prolapsing technique in the patients with low rectal cancer and its clinical prognosis [J]. Chin Med J (Engl), 2008, 121(20): 2016-2020.
[12]
Rullier E, Laurent C, Bretagnol F, et al. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule [J]. Ann Surg, 2005, 241(3): 465-469.
[13]
Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer [J]. Br J Surg, 2012, 99(7): 918-928.
[14]
Gamagami R, Istvan G, Cabarrot P, et al. Fecal continence following partial resection of the anal canal in distal rectal cancer: long-term results after coloanal anastomoses [J]. Surgery, 2000, 127(3): 291-295.
[15]
Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy [J]. Dis Colon Rectum, 2004, 47(4): 459-466.
[16]
刘畅,罗翼,汪晓东, 等. 低位/超低位直肠癌吻合术后评估肛门功能的方法 [J]. 中国普外基础与临床杂志, 2010, 17(9): 910-913.
[17]
Kinugasa T, Akagi Y, Shirouzu K. Benefit of lateral lymph node dissection for rectal cancer: long-term analysis of 944 cases undergoing surgery at a single center (1975-2004) [J]. Anticancer Res, 2014, 34(8): 4633-4639.
[18]
Kinugasa T, Akagi Y, Ochi T, et al. Lateral lymph-node dissection for rectal cancer: meta-analysis of all 944 cases undergoing surgery during 1975-2004 [J]. Anticancer Res, 2013, 33(7): 2921-2927.
[19]
马骏,冯勇,丛进春, 等. 低位直肠癌保肛术后的吻合口水平对排便功能及生活质量的影响 [J]. 世界华人消化杂志, 2009, 17(2): 221-224.
[20]
Huertas A, Marchal F, Peiffert D, et al. Preoperative radiotherapy for rectal cancer: target volumes [J]. Cancer Radiother, 2013, 17(5-6): 477-485.
[21]
Rullier E, Goffre B, Bonnel C, et al. Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum [J]. Ann Surg, 2001, 234(5): 633-640.
[22]
Luna-Perez P, Rodriguez-Ramirez S, Hernandez-Pacheco F, et al. Anal sphincter preservation in locally advanced low rectal adenocarcinoma after preoperative chemoradiation therapy and coloanal anastomosis [J]. J Surg Oncol, 2003, 82(1): 3-9.
[23]
Wang T, Wang J, Deng Y, et al. Neoadjuvant therapy followed by local excision and two-stage total mesorectal excision: a new strategy for sphincter preservation in locally advanced ultra-low rectal cancer [J]. Gastroenterol Rep (Oxf), 2014, 2(1): 37-43.
[24]
Lange MM, van de Velde CJ. Urinary and sexual dysfunction after rectal cancer treatment [J]. Nat Rev Urol, 2011, 8(1): 51-57.
[25]
Khair MA, Rahman MS, Khanam F, et al. Sexual and urinary outcome after surgical treatment for low rectal cancer [J]. Mymensingh Med J, 2013, 22(3): 444-451.
[26]
Morino M, Parini U, Allaix ME, et al. Male sexual and urinary function after laparoscopic total mesorectal excision [J]. Surg Endosc, 2009, 23(6): 1233-1240.
[27]
Attaallah W, Ertekin C, Tinay I, et al. High rate of sexual dysfunction following surgery for rectal cancer [J]. Ann Coloproctol, 2014, 30(5): 210-215.
[28]
顾晋. 中低位直肠癌手术盆腔自主神经保护的现状 [J]. 中国普外基础与临床杂志, 2005, 12(1): 4-6.
[29]
Wells CI, Vather R, Chu MJ, et al. Anterior resection syndrome--a risk factor analysis [J]. J Gastrointest Surg, 2015, 19(2): 350-359.
[30]
Heriot AG, Tekkis PP, Constantinides V, et al. Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection [J]. Br J Surg, 2006, 93(1): 19-32.
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