腹腔镜辅助经肛全直肠系膜切除术治疗下段直肠癌疗效分析

目的 探讨腹腔镜辅助经肛全直肠系膜切除术治疗下段直肠癌的经验。方法 回顾性分析2017年1月至2020年6月间收治的48例腹腔镜辅助经肛全直肠系膜切除术的患者临床资料（A组）,并与同期186例腹腔镜全直肠系膜切除术进行对比分析（B组）。结果 两组病人之间年龄、性别比例、肿瘤最大横径、术中出血量、收获淋巴结个数、术后并发症、术前Wexner评分、术前肛门最大收缩压、术后Wexner评分、术后肛门最大收缩压的差异无统计学意义（P>0.05）。两组病人之间肿瘤下缘至齿线距离、体质指数、手术时间的差异有统计学意义（P<0.05）。在A组内,男性患者和女性患者之间年龄、肿瘤最大横径、新辅助放化疗比例、术中出血量、收获淋巴结、术后并发症比例的差异无统计学意义（P>0.05）,但肿瘤下缘距齿线距离、BMI、手术时间的差异有统计学意义（P<0.05）。结论 腹腔镜辅助经肛全直肠系膜切除术治疗下段直肠癌是有效的,尤其适合于低位、骨盆狭窄的男性直肠癌患者,但要充分准备,有序开展。

Laparoscopic assisted transanal total mesorectal excision for lower rectal cancer： an analysis of 48 cases

Objective To explore the preliminary experience of laparoscopic assisted transanal total mesorectal excision in the treatment of lower rectal cancer. Methods The clinical data of 48 patients with laparoscopic assisted transanal total mesorectal excision from January 2017 to June 2020 were retrospectively analyzed （group A）, and compared with 186 patients with laparoscopic total mesorectal excision in the same period （group B）. Results There were no statistically significant differences in age, sex ratio, mean maximum tumor diameter, mean intraoperative blood loss, mean number of harvested lymph nodes, postoperative complications, preoperative Wexner score, preoperative anal maximum systolic pressure, postoperative Wexner score and postoperative anal maximum systolic pressure between group A and B （P>0.05）. However, there were significant differences between the two groups in the average distance from the lower edge of the tumor to the dental line, the average body mass index, and the average operation time （P<0.05）. In group A, there was no significant difference in age, maximum diameter of tumor, proportion of neoadjuvant radiotherapy and chemotherapy, blood loss during operation, lymph nodes harvested and postoperative complications （P>0.05）, but the difference between the distance between the lower margin of tumor and the dental line, BMI and operation time was statistically significant （P<0.05）. Conclusions Laparoscopic assisted transanal total mesorectal excision is effective in the treatment of lower rectal cancer, especially for male patients with low rectal cancer and pelvic stenosis, but it should be fully prepared and carried out orderly.