| 双腹腔镜下TME及ISR术治疗低位直肠癌的临床研究 |
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| 引用本文： | 段乐乐,刘晶晶.双腹腔镜下TME及ISR术治疗低位直肠癌的临床研究[J].现代肿瘤医学,2020,0(14):2457-2461. |
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| 作者姓名： | 段乐乐 刘晶晶 |
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| 作者单位： | 咸宁市中心医院肛肠科（湖北科技学院附属第一医院肛肠科），湖北 咸宁 437000 |
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| 摘 要： | 目的:评估双腹腔镜行全直肠系膜切除术（TME）及内括约肌切除保肛术（ISR）治疗低位直肠癌的疗效及安全性。方法:纳入2015年1月至2016年1月我院收治的低位直肠癌患者70例，采用随机数表法分为观察组、对照组各35例，观察组在双腹腔镜下实施TME及ISR术，对照组实施经腹会阴直肠癌根治术（Miles术），比较两组手术相关指标、术后6个月内Kirwan肛门功能评分及血清指标变化、癌症生活质量问卷（QLQ-C30）、满意度、预后。结果:观察组手术时间、术中出血量、住院时间及胃肠功能恢复时间短/低于对照组，观察组淋巴结清扫数目较对照组多（P＜0.05）；术后3个月、6个月观察组Kirwan评分较对照组低（P＜0.05）；术后观察组血清癌胚抗原（CEA）、C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）水平低于对照组（P＜0.05）；观察组术后3个月、6个月QLQ-C30评分较对照组高（P＜0.05）；观察组满意度85.71%高于对照组62.86%（P＜0.05）；观察组术后6个月并发症发生率8.57％低于对照组28.57%；术后1年两组复发率、生存率比较差异无统计学意义（P＞0.05），观察组术后2年复发率2.86%低于对照组20.00%，生存率80.00%高于对照组57.14%（P＜0.05）。结论:对低位直肠癌患者在双腹腔镜下行TME及ISR术治疗疗效较Miles术好，可明显减少创伤、出血量，缩短康复进程，并保留肛门功能，提高术后生活质量，治疗效果满意，值得在临床推广实践。
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| 关 键 词： | 双腹腔镜 低位直肠癌 全直肠系膜切除 内括约肌切除保肛术 |
Clinical study of double laparoscopic TME and ISR in the treatment of low rectal cancer |
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| Duan Lele,Liu Jingjing.Clinical study of double laparoscopic TME and ISR in the treatment of low rectal cancer[J].Journal of Modern Oncology,2020,0(14):2457-2461. |
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| Authors: | Duan Lele Liu Jingjing |
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| Affiliation: | Anorectal Department,Xianning Central Hospital (Anorectal Department,the First Affiliated Hospital of Hubei Institute of Science and Technology),Hubei Xianning 437000,China. |
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| Abstract: | Objective:To evaluate the curative effect and safety of double laparoscopic total mesorectal excision (TME) and anus-preserving intersphincteric resection (ISR) in the treatment of low rectal cancer.Methods:70 patients with low rectal cancer who were admitted to the hospital from January 2015 to January 2016 were selected and randomly divided into the observation group and the control group by the random number table method,35 patients in each group.The observation group was treated by double laparoscopic TME and ISR while the control group was treated by abdominoperineal radical resection of rectal cancer (Miles surgery).The surgery related indexes,the Kirwan anal function score within 6 months after surgery,changes of serum indexes,Core Quality of Life Questionnaire (QLQ-C30),satisfaction and prognosis were compared between the two groups.Results:The surgical time,intraoperative blood loss,length of stay and time of gastrointestinal function recovery in the observation group were significantly shorter/less than those in the control group,and dissected lymph nodes were more than those in the control group (P＜0.05).3 months and 6 months after surgery,the Kirwan scores of the observation group were lower than those of the control group (P＜0.05).After surgery,levels of serum carcinoembryonic antigen (CEA),C reactive protein (CRP) and tumor necrosis factor alpha (TNF-α) in the observation group were lower than those in the control group (P＜0.05).The QLQ-C30 scores of the observation group were higher than those of the control group at 3 months and 6 months after operation (P＜0.05).The satisfaction rate of the observation group was higher than that of the control group (85.71% vs 62.86%) (P＜0.05).The incidence rate of complications in the observation group in 6 months after surgery was lower than that in the control group (8.57% vs 28.57%).There was no significant difference in the 1-year survival rate or recurrence rates between the two groups (P>0.05).The recurrence rate in the observation group in 2 years after surgery was lower than that in the control group (2.86% vs 20.00%) but the survival rate was higher than that of the control group (80.00% vs 57.14%) (P＜0.05).Conclusion:The effect of double laparoscopic TME and ISR is better than Miles surgery in the treatment of low rectal cancer.The former can reduce trauma and blood loss,shorten the rehabilitation process,preserve anal function and improve postoperative quality of life,with satisfying curative effect. |
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| Keywords: | double laparoscope low rectal cancer total mesorectal excision anus-preserving intersphincteric resection |
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