[1]王占文① 段国强 张伦② 王丽亭 胡旭亚 张占学*.三联合腹腔镜手术在低位直肠癌保肛手术中的应用价值[J].中国微创外科杂志,2022,01(3):213-217.
　Wang Zhanwen,Duan Guoqiang*,Zhang Lun,et al.Application Value of Three United Laparoscopic Surgery in Anal Preservation Surgery for Low Rectal Cancer[J].Chinese Journal of Minimally Invasive Surgery,2022,01(3):213-217.
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三联合腹腔镜手术在低位直肠癌保肛手术中的应用价值()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年3期
页码:
213-217
栏目:
临床研究
出版日期:
2022-06-02

文章信息/Info

Title:
Application Value of Three United Laparoscopic Surgery in Anal Preservation Surgery for Low Rectal Cancer
作者:
王占文① 段国强 张伦② 王丽亭 胡旭亚 张占学*
(河北医科大学第二医院普外二科，石家庄050000)
Author(s):
Wang Zhanwen;  Duan Guoqiang*;  Zhang Lun;  et al.
*Department of General Surgery, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
关键词:
三联合腹腔镜手术; 腹腔镜辅助手术; 低位直肠癌; 保肛手术
Keywords:
Three united laparoscopic surgery; Laparoscopy assisted surgery; Low rectal cancer; Anal preservation surgery
文献标志码:
A
摘要:
目的探讨腹腔镜、手助和开放相结合的三联合腹腔镜手术(three united laparoscopic surgery，TULS)在低位直肠癌保肛手术中的应用价值。方法回顾2015年6月~2018年6月河北医科大学第二医院43例低位直肠癌保肛手术资料，由患者选择术式，其中TULS 22例，腹腔镜辅助21例。TULS组先利用腹腔镜探查及游离直肠，再改为手助腹腔镜进一步游离直肠并完成直肠离断，开放手术切除病变直肠，手助腹腔镜下完成直肠吻合。比较2组手术及术后指标。结果与腹腔镜辅助组相比，TULS组肛缘距吻合环距离短［(4.83±0.46)cm vs. (5.50±0.54)cm，t=-4.369，P=0.000］，肿瘤下缘距切缘的距离长［(199±0.35)cm vs. (1.41±0.18)cm，t=6.825，P=0.000］，肿瘤下缘距切缘距离>1.5 cm占比高［90.9%(20/22) vs. 571%(12/21), χ2=6.435, P=0.011］，2组手术时间、术中出血量、淋巴结清扫数目、自主排便时间及并发症发生率差异无统计学意义(P>0.05)。术后均随访3年，2组生存率差异无统计学意义(log rank χ2=0.019，P=0.889)。结论TULS在低位直肠癌保肛术中安全可行，较腹腔镜辅助手术更具优势。
Abstract:
ObjectiveTo investigate the application value of the three united laparoscopic surgery (TULS) in anal preservation surgery for low rectal cancer.MethodsClinical data of 43 cases of anal preservation surgery for low rectal cancer in our hospital from June 2015 to June 2018 were reviewed. The operation methods were selected by the patients, including 22 cases in TULS group and 21 cases in laparoscopic assisted group. In the TULS group, laparoscopy was used to probe and free the rectum, then turned to handassisted laparoscopy to further free and disconnect rectum. The open surgery was performed to resect the diseased rectum, and then under handassisted laparoscopy the rectal anastomos was carried out.ResultsCompared with the laparoscopic assisted group, the distance between the anal edge and the anastomotic ring in the TULS group was shorter ［(4.83±0.46) cm vs. (5.50±0.54) cm, t=-4.369, P=0.000］, the distance between the lower edge of the tumor and the cutting edge was longer ［(199±0.35) cm vs. (1.41±0.18) cm, t=6.825, P=0.000］, and the proportion of the distance between the lower edge of the tumor and the cutting edge >1.5 cm was higher ［90.9% (20/22) vs. 57.1% (12/21), χ2=6.435, P=0.011］. There were no significant differences in operation time, intraoperative bleeding, number of lymph node dissections, self defecation time and complications between the two groups (all P>0.05). All the patients were followed up for 3 years. There was no significant difference in the survival rate between the two groups (log rank χ2=0.019, P=0.889).ConclusionTULS is safe and feasible in anus preserving surgery for low rectal cancer, and has more advantages than laparoscopic assisted surgery.

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备注/Memo

备注/Memo:
*通讯作者，Email：13363858865@189.cn ①(河北省石家庄市第二医院普外科，石家庄050051) ②(河北省深州市人民医院普外科，衡水053800)
更新日期/Last Update: 2022-06-02