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 ›› 2023, Vol. 12 ›› Issue (04) : 303 -310. doi: 10.3877/cma.j.issn.2095-3224.2023.04.006

论著

腹腔镜下低位直肠癌Miles术中折刀位与截石位近期临床疗效对比分析
刘曙光, 宋彦呈, 李兆鹏, 李兆, 郭栋, 袁辰桐, 陈栋, 牛兆建, 李宇()   
  1. 266003 青岛大学附属医院胃肠外科
  • 收稿日期:2022-12-02 出版日期:2023-08-25
  • 通信作者: 李宇
  • 基金资助:
    山东省医药卫生科技发展计划项目(202204010913)

Comparative analysis of the short-term clinical efficacy of Miles' surgery the prone folding knife position and the traditional lithotomy position in laparoscopy low rectal cancer

Shuguang Liu, Yancheng Song, Zhaopeng Li, Zhao Li, Dong Guo, Chentong Yuan, Dong Chen, Zhaojian Niu, Yu Li()   

  1. Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao 266003, China
  • Received:2022-12-02 Published:2023-08-25
  • Corresponding author: Yu Li
引用本文:

刘曙光, 宋彦呈, 李兆鹏, 李兆, 郭栋, 袁辰桐, 陈栋, 牛兆建, 李宇. 腹腔镜下低位直肠癌Miles术中折刀位与截石位近期临床疗效对比分析[J/OL]. 中华结直肠疾病电子杂志, 2023, 12(04): 303-310.

Shuguang Liu, Yancheng Song, Zhaopeng Li, Zhao Li, Dong Guo, Chentong Yuan, Dong Chen, Zhaojian Niu, Yu Li. Comparative analysis of the short-term clinical efficacy of Miles' surgery the prone folding knife position and the traditional lithotomy position in laparoscopy low rectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(04): 303-310.

目的

探讨腹腔镜下Miles术式在折刀位与截石位治疗低位直肠癌的近期临床疗效。

方法

回顾性分析青岛大学附属医院2017年1月至2021年7月于腹腔镜下行Miles手术治疗的214例低位直肠癌患者临床资料,按照手术体位不同将患者分为两组,折刀位组55例,截石位组159例。按1:2倾向性评分匹配后两组共纳入165例进行后续分析。观察比较两组手术相关指标、术后引流管引流量、术后胃肠道功能恢复情况、术后血液检查结果、术后早期并发症情况、切除标本病理学检查结果。

结果

折刀位组手术中出血量少于截石位组,且差异具有统计学意义(t=-4.05,P<0.05),术后会阴部切口引流管第一天引流量(Z=-2.10,P<0.05)、第二天引流量(Z=-2.46,P<0.05)、第三天引流量(Z=-2.39,P<0.05)均少于截石位组引流量,差异具有统计学意义;术后炎症指标C反应蛋白(CRP)最高值低于截石位患者,差异具有统计学意义(t=-2.38,P<0.05);术后患者出院会阴部带引流管率差异具有统计学意义(χ2=4.76,P<0.05)。

结论

从近期的临床疗效来看腹腔镜下低位直肠癌Miles手术折刀位与截石位组总体上差异无统计学意义,但前者术中出血量较少,术后创面渗出较少,术后炎症反应轻,对患者术后恢复具有一定的优势。

Objective

To analyze the short-term clinical efficacy of laparoscopic Miles' surgery in prone jackknife position and traditional lithotomy position for low rectal cancer.

Methods

The clinical data of 214 patients with low rectal cancer treated by laparoscopic Miles' surgery from January 2017 to July 2021 in The Affiliated Hospital of Qingdao University were retrospectively analyzed. According to different surgical position,all patients was divided into 55 patients in the prone jackknife position group and 159 patients in the traditional lithotomy position group. A total of 165 cases were included in the two groups after 1:2 tendency score matching for subsequent analysis.The following data were compared between the two groups: surgical related indicators, postoperative drainage tube drainage, postoperative gastrointestinal function recovery, postoperative blood examination results, early postoperative complications, and pathological examination results of the resection specimens.

Results

The amount of bleeding in the laparoscopic lower rectal cancer prone jackknife position group was less than that in the traditional lithotomy position group (t=-4.05, P<0.05). The drainage flow of the first day (Z=-2.10, P<0.05), the second day (Z=-2.46, P<0.05) and the third day(Z=-2.39, P<0.05) in the prone jackknife position group were less than that of the traditional lithotomy position group. The highest C reactive protein(CRP) value of postoperative inflammation index in the prone jackknife position group was lower than that of patients with the traditional lithotomy position group (t=-2.38, P<0.05). The postoperative discharge rate was statistically significant (χ2=4.76, P<0.05).

Conclusion

From the short-term clinical efficacy, there was no significant difference in the laparoscopic Miles' surgical prone jackknife position for low rectal cancer and the traditional lithotomy group, but the former has less intraoperative bleeding, less postoperative wound exudation and less postoperative inflammation, which has certain advantages for postoperative recovery of patients.

表1 倾向性评分匹配前、后两组一般资料比较[
x¯
±s,例(%)]
临床基本资料 倾向性评分匹配前 倾向性评分匹配后
折刀位(n=55) 截石位(n=159) t/χ2 P 折刀位(n=55) 截石位(n=110) t/χ2 P
性别(%) 0.886 0.347 0.314 0.575
31(56.4) 101(63.5) 31(56.4) 67(60.9)
24(43.6) 58(36.5) 24(43.6) 43(39.1)
年龄(岁) 61.51±8.666 61.42±9.875 -0.063 0.950 61.51±8.666 61.75±9.806 -0.152 0.880
身体质量指数(kg/m2 25.55±3.319 24.325±3.131 -2.462 0.015 25.55±3.319 24.94±3.059 1.167 0.245
高血压 0.007 0.935 0.160 0.689
44(80.0) 128(80.5) 44(80.0) 85(77.3)
11(20.0) 31(19.5) 11(20.0) 25(22.7)
糖尿病 0.100 0.751 0.138 0.710
49(89.1) 144(90.6) 49(89.1) 100(90.9)
6(10.9) 15(9.4) 6(10.9) 10(9.1)
新辅助化疗 2.869 0.090 1.650 0.199
42(76.4) 137(86.2) 42(76.4) 93(84.5)
13(23.6) 22(13.8) 13(23.6) 17(15.5)
新辅助放疗 2.456 0.117 0.950 0.330
42(76.4) 136(85.5) 42(76.4) 91(82.7)
13(23.6) 23(14.5) 13(23.6) 19(17.3)
肛诊肿瘤距肛缘距离(cm) 2.92±1.150 3.35±1.304 2.223 0.020 2.92±1.150 3.00±1.151 -0.430 0.667
电子结肠镜肿瘤距肛缘距离(cm) 2.86±1.256 3.44±1.500 2.570 0.006 2.86±1.256 2.96±1.345 -0.460 0.646
分化程度 1.319 0.517 1.567 0.457
低分化腺癌 6(10.9) 10(6.3) 6(10.9) 7(6.3)
中分化腺癌 38(69.1) 118(74.2) 38(69.1) 85(77.3)
高分化腺癌 11(20.0) 31(19.5) 11(20.0) 18(16.4)
临床分期
cT分期 1.075 0.783 0.635 0.728
T1 0(0.0) 1(0.6) 0(0.0) 0(0.0)
T2 6(10.9) 20(12.6) 6(10.9) 17(15.5)
T3 47(85.5) 128(80.5) 47(85.5) 89(80.9)
T4 2(3.6) 10(6.3) 2(3.6) 4(3.6)
cN分期 5.597 0.133 3.991 0.262
N0 16(29.1) 31(19.5) 16(29.1) 22(20.0)
N1 15(27.3) 44(27.7) 15(27.3) 32(29.1)
N2a 23(41.8) 84(52.8) 23(41.8) 56(50.9)
N2b 1(1.8) 0(0.0) 1(1.8) 0(0.0)
癌胚抗原CEA[ng/mL(%)] 1.503 0.220 2.114 0.146
≤3.4 27(49.1) 63(39.6) 27(49.1) 41(37.3)
>3.4 28(50.9) 96(60.4) 28(50.9) 69(62.7)
CA19-9[U/mL(%)] 0.787 0.375 0.167 0.683
≤39.0 50(90.9) 150(94.3) 50(90.9) 102(92.7)
>39.0 5(9.1) 9(5.7) 5(9.1) 8(7.3)
图1 截石位。1A:会阴部手术前;1B:会阴部手术后创面
图2 俯卧折刀位。2A:会阴部手术前;2B:会阴部手术后创面
表2 手术相关指标、术后引流管引流量、胃肠道功能恢复情况比较[
x¯
±s,例(%)]
表3 术后早期并发症指标比较[例(%)]
表4 术后血液检查指标对比(
x¯
±s
表5 切除标本病理学检查结果比较[
x¯
±s,例(%)]
[1]
中华人民共和国国家卫生健康委员会. 中国结直肠癌诊疗规范(2020年版)[J]. 中华外科杂志, 2020, 58(8): 561-585.
[2]
中国抗癌协会, 中国抗癌协会大肠癌专业委员会. 中国恶性肿瘤整合诊治指南-直肠癌部分[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(2): 89-103.
[3]
魏东. 低位直肠癌外科治疗现状与展望[J]. 世界华人消化杂志, 2016, 24(21): 3238-3247.
[4]
Garcia-Henriquez N, Galante DJ, Monson JRT. Selection and outcomes in abdominoperineal resection[J]. Frontiers in Oncology, 2020, 10: 1339.
[5]
孟宝仓. 不同体位下腹腔镜Miles术治疗低位直肠癌的效果及预后观察[J]. 中国医学工程, 2021, 29(8): 84-87.
[6]
李婷婷, 陈蓉, 邵蕾, 等. 折刀位腹腔镜Miles术与截石位腹腔镜Miles术治疗低位直肠癌的临床效果[J]. 结直肠肛门外科, 2020, 26(S2): 19-20.
[7]
苏加庆, 毕建威. 单孔腹腔镜联合折刀位低位直肠癌Miles术与四孔截石位对比分析[J]. 中国医师进修杂志, 2014, 37(17): 62-65.
[8]
鲍扬, 江志伟, 王刚, 等. 腹腔镜联合折刀位直肠癌腹会阴根治术[J]. 腹腔镜外科杂志, 2011, 16(10): 752-754.
[9]
刘江, 王刚, 赵健, 等. 达芬奇机器人联合折刀位行经腹会阴直肠癌根治术[J]. 中华腔镜外科杂志(电子版), 2018, 11(1): 39-42.
[10]
Stelzner S, Holm T, Moran BJ, et al. Deep pelvic anatomy revisited for a description of crucial steps in extralevator abdominoperineal excision for rectal cancer[J]. Dis Colon Rectum, 2011, 54(8): 947-957.
[11]
Liu P, Bao H, Zhang X, et al. Better operative outcomes achieved with the prone jackknife vs. lithotomy position during abdominoperineal resection in patients with low rectal cancer[J]. World Journal of Surgical Oncology, 2015, 13: 39.
[12]
Kumar P, Mishra TS, Sarthak S, et al. Lithotomy versus prone position for perianal surgery: a randomized controlled trial[J]. Annals of Coloproctology, 2022, 38(2): 117-123.
[13]
张溪, 陈孟. 折刀位腹腔镜Miles术治疗老年直肠癌的效果和临床优势[J]. 中国现代普通外科进展, 2019, 22(7): 548-550+553.
[14]
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.
[15]
Chang C, Lan Y, Jiang J, et al. Risk factors for delayed perineal wound healing and its impact on prolonged hospital stay after abdominoperineal resection[J]. World Journal of Surgical Oncology, 2019, 17(1): 226.
[16]
彭利盼. 直肠癌Miles术后会阴部切口感染的相关因素分析[J]. 中国实用医刊, 2018, 45(20): 5-7.
[17]
王海锋, 刘江, 王刚, 等. 折刀位与截石位行直肠癌腹会阴联合切除术近期疗效的比较研究[J]. 腹腔镜外科杂志, 2019, 24(3): 212-216.
[18]
McKechnie T, Lee Y, Springer JE, et al. Prone compared with lithotomy for abdominoperineal resection: a systematic review and meta-analysis[J]. Journal of Surgical Research, 2019, 243: 469-480.
[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] 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.
[11] 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.
[12] 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.
[13] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143.
[14] 李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-144.
[15] 魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145.
阅读次数
全文


摘要