腹腔镜直肠癌直肠全系膜切除保肛手术的临床体会
·外科研究·
系统医学SYSTEMS MEDICINE 系统医学2019年3月第4卷第5期
直肠全系膜切除(TME)是治疗直肠癌的重要方
式,但是腹腔镜下手术并未像腹腔镜胆囊切除术那样
被患者所广泛接受,部分专家学者仍然对该技术的安
全性与有效性存在较多疑虑,而且针对这一技术治疗
直肠癌的研究相对较少,缺乏可供参考的临床资料[1]。该研究采集该院2015年1月—2017年12月间收治
的64例直肠癌患者,对腹腔镜下行直肠癌TME保肛
手术的可行性与临床疗效报道如下。1资料与方法
1.1一般资料
将该院收治的64例直肠癌患者纳入研究,所有患者均符合直肠癌临床诊断标准,自愿接受手术治疗,该研究已获得该院医学伦理委员会审核批准,患者及其家属完全知情同意。根据手术方法不同将64例患者分为观察组和对照组,每组32例,观察组实施腹腔镜下TME保肛手术,其中男性患者18例,女性患者14例,年龄45~77岁,平均年龄(57.30±7.42)岁,临床分期:Ⅰ期10例,Ⅱ期14例,Ⅲ期5例,Ⅳ期3例,对照组实施传统开腹手术,其中男性患者16例,
DOI:10.19368/https://www.wendangku.net/doc/fb11266962.html,ki.2096-1782.2019.05.078
腹腔镜直肠癌直肠全系膜切除保肛手术的临床体会
尹登贵
禄丰县人民医院普外科,云南禄丰651200
[摘要]目的探讨腹腔镜下行直肠癌直肠全系膜切除保肛手术的可行性与临床疗效。方法选取2015年1月—2017年12月间该院收治的64例直肠癌患者,随机分为两组,每组32例,观察组实施腹腔镜下TME保肛手术,对照组实施传统开腹手术,比较两组手术学、术后恢复指标与随访结果。结果除手术时间外,观察组手术学指标[术中出血量(52.96±14.55)mL vs(172.34±39.76)mL]与术后恢复指标[肠功能恢复时间(2.11±0.97)d vs(3.89±1.10)d、下床活动时间(5.54±1.27)d vs(8.90±2.31)d]、住院时间[(13.17±2.34)d vs(17.86±3.11)d])均显著优于对照组,差异有统计学意义(P<0.05),随访可知两组复发率(0.00%vs3.13%,χ2=0.065)、转移率(3.13%vs0.00%,χ2= 1.134)与生存率(96.88%vs100.00%,χ2=0.706)相近,差异无统计学意义(P>0.05)。结论腹腔镜下行直肠癌直肠
全系膜切除保肛手术治疗效果值得肯定,临床应用价值较高。
[关键词]直肠癌;腹腔镜;直肠全系膜切除;保肛手术;临床效果
[中图分类号]R735.3+7[文献标识码]A[文章编号]2096-1782(2019)03(a)-0078-03 Clinical Experience of Laparoscopic Rectal Cancer with Total Mesorectal Excision
YIN Deng-gui
Department of General Surgery,Lufeng County People's Hospital,Lufeng,Yunnan Province,651200China
[Abstract]Objective To investigate the feasibility and clinical efficacy of laparoscopic rectal cancer with total mesorectal excision.Methods64patients with rectal cancer admitted to our hospital from January2015to December 2017were randomly divided into two groups,32patients in each group.The observation group underwent laparoscopic TME anal sphincter operation and the control group underwent traditional open surgery,comparing the surgical and postoperative recovery indicators and follow-up results of the two groups.Results In addition to the operation time,the surgical parameters of the observation group[intraoperative blood loss(52.96±14.55)mL vs(172.34±39.76)mL]and postoperative recovery index[intestinal function recovery time(2.11±0.97)d vs(3.89±1.10)d],time to get out of bed (5.54±1.27)d vs(8.90±2.31)d,hospitalization time(13.17±2.34)d vs(17.86±3.11)d]were significantly better than the control group,the difference was statistically significant(P<0.05).The follow-up rate showed the recurrence rate(0vs 3.13%,χ2=0.065),metastasis rate(3.13%vs0.00%,χ2=1.134)and survival rate(96.88%vs.100.00%,χ2=0.706),the difference was not statistically significant(P>0.05).Conclusion The effect of laparoscopic rectal cancer with total mesorectal excision and anal sphincter preservation is worthy of affirmation,and its clinical application value is high.
[Key words]Rectal cancer;Laparoscopy;Total mesorectal excision;Anal sphincter preservation;Clinical effect
[作者简介]尹登贵(1973-),男,云南禄丰人,本科,副主任
医师,主要从事普外科临床方面工作。
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