切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2018, Vol. 07 ›› Issue (02) : 162 -166. doi: 10.3877/cma.j.issn.2095-3224.2018.02.012

所属专题: 文献

论著

腹腔镜ISR治疗低位直肠癌的肿瘤学疗效及肛门功能观察
曾华平1,(), 刘凤祝1, 刘擎1   
  1. 1. 100072 丰台,北京市丰台中西医结合医院普外科
  • 收稿日期:2017-12-29 出版日期:2018-04-25
  • 通信作者: 曾华平

Laparoscopic ISR in the treatment of low rectal cancer: oncological efficacy and anal function

Huaping Zeng1,(), Fengzhu Liu1, Qing Liu1   

  1. 1. Department of General Surgery, Beijing Fengtai Integrated Traditional Chinese Medicine and Western Medicine Hospital, Beijing 100072, China
  • Received:2017-12-29 Published:2018-04-25
  • Corresponding author: Huaping Zeng
  • About author:
    Corresponding author: Zeng Huaping, Email:
引用本文:

曾华平, 刘凤祝, 刘擎. 腹腔镜ISR治疗低位直肠癌的肿瘤学疗效及肛门功能观察[J/OL]. 中华结直肠疾病电子杂志, 2018, 07(02): 162-166.

Huaping Zeng, Fengzhu Liu, Qing Liu. Laparoscopic ISR in the treatment of low rectal cancer: oncological efficacy and anal function[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2018, 07(02): 162-166.

目的

探讨腹腔镜内外括约肌间切除术(ISR)治疗低位直肠癌的肿瘤学疗效及对肛门功能的影响。

方法

回顾性分析北京市丰台中西医结合医院78例低位直肠癌患者的临床资料,其中行腹腔镜ISR(观察组)42例,开腹ISR(对照组)36例。对比两组手术相关指标、肿瘤学疗效、肛门功能分级、术后并发症发生率及术后生存率。

结果

两组手术时间比较差异无显著统计学意义(t=1.208,P>0.05)。观察组术中出血量显著低于对照组,通气时间、禁食时间、住院时间显著短于对照组(均P<0.05)。两组淋巴结检出数目、肿瘤大小、肿瘤下缘距远端切缘长度、组织分化程度、TNM分期比较差异无统计学意义(均P>0.05)。两组Wexner评分、排便频率、排便紧迫感、控粪能力降低、Kirwan肛门功能分级比较无统计学意义(均P>0.05)。观察组术后并发症发生率显著低于对照组(χ2=5.520,P<0.05)。两组术后3年生存率比较差异无统计学意义(χ2=1.065,P>0.05)。

结论

腹腔镜ISR与开腹ISR治疗低位直肠癌在肿瘤学疗效、术后生存率及对肛门功能影响方面的效果相当,但前者手术创伤更小,可降低术中出血量,促进患者康复,减少并发症的发生,更具临床应用价值。

Objective

To investigate the efficacy of laparoscopic internal and external resection of the sphincter (ISR) in the treatment of low rectal cancer and its influence on anal function.

Methods

Seventy-eight patients with low rectal cancer in Beijing Fengtai Integrated Traditional Chinese Medicine and Western Medicine Hospital were retrospectively analyzed, including forty-two cases of laparoscopic ISR (observation group) and thirty-six cases of open ISR (control group). The operation related indexes, oncological efficacy, anal function classification, postoperative complication rate and postoperative survival rate were compared between the two groups.

Results

There was no significant difference in the operation time between the two groups (t=1.208, P>0.05). The intraoperative blood loss in the observation group was significantly lower than that in the control group, and the ventilation time, fasting time and length of stay were significantly shorter than those in the control group (P<0.05). The number of lymph nodes detected, the size of tumor, the length of distal margin of tumor, the degree of tissue differentiation and TNM staging were not significantly different between the two groups (P>0.05). Two Wexner score, frequency of defecation, urgency of defecation, bowel control reduce, Kirwan anal function grading were not statistically significant between the two groups (P>0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group (χ2=5.520, P<0.05). There was no significant difference in the 3 year survival rate between the two groups (χ2=1.065, P>0.05).

Conclusions

The effect of laparoscopic ISR and open ISR on the efficacy of oncology, survival rate and anorectal function in patients with low rectal cancer is comparable, but the former is less traumatic, reduces intraoperative bleeding, promotes rehabilitation, reduces complications, and has more clinical application value.

表1 两组手术相关指标比较(±s
表2 两组肿瘤学疗效比较
表3 两组肛门功能比较
表4 两组术后并发症发生率比较[例(%)]
图1 两组术后3年生存率分析
[1]
褚晓晖,顾佳妮.低位直肠癌手术进展 [J]. 结直肠肛门外科, 2015, 31(3): 222-224.
[2]
曾国祥.双吻合术预防低位直肠癌术后吻合口漏的临床研究 [J]. 结直肠肛门外科, 2016, 23(5): 509-512.
[3]
黄颖,池畔.低位直肠癌行腹腔镜内括约肌切除术技巧与要领 [J]. 中国实用外科杂志, 2017, 37(6): 695-698.
[4]
汪晓东,甘志明,阳川华, 等.预防性造口对超低位直肠/肛管癌患者保肛术后肛门功能及生存质量的影响 [J]. 现代医学, 2015, 43(4): 472-475.
[5]
梁勇,宋虎,徐溢新, 等.腹腔镜保肛手术与开腹保肛手术对低位直肠癌的疗效比较 [J]. 蚌埠医学院学报, 2016, 41(12): 1616-1618.
[6]
才保加,张成武,王晓龙, 等.经自然腔道腹腔镜下低位直肠癌根治术3例体会 [J]. 中华结直肠疾病电子杂志, 2015, 4(2): 59-61.
[7]
马磊,丁克,刘广余, 等.经肛门括约肌间切除术治疗超低位直肠癌根治效果及术后肛门功能观察 [J]. 中华胃肠外科杂志, 2015, 18(7): 688-692.
[8]
穆丽,许慧.800例腹腔镜下直肠癌根治术配合体会 [J]. 中华结直肠疾病电子杂志, 2014, 3(2): 54-56.
[9]
甄亚男,肖瑞雪,徐慧荣, 等.腹腔镜肛门括约肌间超低位直肠癌根治术与开腹手术疗效的Meta分析 [J]. 国际肿瘤学杂志, 2016, 43(1): 17-22.
[10]
周彤,张广军,刘作良, 等.腹腔镜与开腹经括约肌间超低位直肠癌保肛手术的临床对照研究 [J]. 中华胃肠外科杂志, 2013, 16(6): 565-569.
[11]
黄胜辉,池畔,林惠铭, 等.腹腔镜与开放经腹括约肌间切除术治疗低位直肠癌的近期疗效比较 [J]. 中华胃肠外科杂志, 2016, 19(8): 923-927.
[12]
方复,卢国春,毛华辉.腹腔镜全系膜切除术联合经肛门内括约肌切除术治疗超低位直肠癌的疗效分析 [J]. 中华全科医学, 2017, 15(4): 724-726.
[13]
陈志良,叶平江,李振军, 等.腹腔镜下ISR与超低位Dixon术后肛门功能的比较分析 [J]. 浙江医学, 2016, 38(12): 991-993.
[1] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[2] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[3] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[4] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[5] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[6] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[7] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[8] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[9] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[10] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[11] 李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[12] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[13] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[14] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[15] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
阅读次数
全文


摘要