经肛内镜与腹腔镜下全直肠系膜切除治疗低位直肠癌的对比研究

目的 探讨经肛内镜与腹腔镜下全直肠系膜切除治疗低位直肠癌的临床效果.方法 将2008年10月至201 1年10月浙江金华广福医院收治的64例低位直肠癌患者根据患者意愿随机分为腹腔镜组（34例）和经肛内镜组（30例）,腹腔镜组在腹腔镜下行全直肠系膜切除术,经肛内镜组在肛内镜下完成手术,比较2组的手术时间、术中出血量、术后肛门排气时间、住院时间、术后并发症及2年后随访肿瘤复发情况.结果 腹腔镜组与经肛内镜组手术时间、术中出血、肛门排气时间、住院时间分别为（205±10） min和（135 ± 10）min,（96±10）ml和（42 ±9）ml,（88 ±8）min和（53 ±6） min,（17.8±2.3）d和（10.0±2.0）d,2组间比较差异均有统计学意义（均P＜0.05）.腹腔镜组患者发现术后并发症8例（23.5％）,其中出血4例、吻合口漏3例、肺部感染1例,而经肛内镜组患者发现9例（30.0％）,其中出血3例、肛门失禁3例、肠穿孔 2例、肺部感染1例,2组术后并发症比较差异无统计学意义（P＞0.05）.经2年随访结果发现,腹腔镜组和经肛内镜组在直肠局部复发率、远处转移发生率、2年生存率、2年无瘤生存率的比较差异均无统计学意义（均P＞0.05）.结论 经肛内镜与腹腔镜下全直肠系膜切除术治疗低位直肠癌均具有创伤小、出血少、恢复快等优点,但对于早期直肠癌治疗选取经肛内镜治疗,对患者生理影响更少,是一种较为理想的手术方式.

Endoscopic and laparoscopic under anal total mesorectal excision treating lower colorectal cancer

Objective To evaluate the clinical efficacy of endoscopic and laparoscopic under anal total mesorectal excision treatment of lower colorectal cancer.Methods Totally 64 cases with low colorectal cancer from October 2008 to October 2011 in our hospital according to the wishes of the patients were randomly divided into the laparoscopic group （34 cases） and anal endoscopic group （30 cases）.Operative time,blood loss,postoperative anal exhaust time,postoperative complications,and 2-year follow-up of tumor recurrence were compared.Results The operation time,bleeding volume,anal exhaust time,hospitalization time in laparoscopic group and anal endoscopic surgery group were （205 ± 10）min and （135 ± 10）min,（96 ± 10） ml and （42 ± 9）ml,（88 ± 8） min and （53 ± 6） min,（17.8 ± 2.3） d and （10.0 ± 2.0） d,there were statistically significant differences between the two groups （all P ＜ 0.05）.The postoperative complications in the laparoscopic group were found in eight cases,in which bleeding,anastomotic leakage based,and anal endoscopic patients found nine cases,with bleeding,incontinence,bowel perforation based,the performance was different,but the difference was not statistically significant （P ＞ 0.05）.After 2 years of follow-up there was no significant the rate of local recurrence in the rectum,the incidence of distant metastasis,2-year survival,difference in disease-free survival comparing 2 years between two groups （all P ＞ 0.05）.Conclusion Under endoscopic and laparoscopic rectal by total mesorectal excision for colorectal cancer are with less trauma,less bleeding and faster recovery.