自制平臺腔鏡下經肛輔助入路全直腸系膜切除術在中低位直腸癌患者中的應用效果

王運成　翟剛　岑川

[摘要] 目的 觀察自制操作平臺腔鏡下經肛輔助入路全直腸系膜切除術（TME）在中低位直腸癌患者中的應用效果。 方法 選取2016年6月～2018年6月百色市人民醫院普外科收治的中低位直腸癌患者45例，按照隨機數字表法將其分為兩組，其中觀察組20例，對照組25例。對照組患者行常規腹腔鏡TME，觀察組使用自制平臺腔鏡下經肛入路與經腹結合TME。比較兩組手術相關指標及手術切除直腸標本病理學情況;比較兩組治療相關費用;隨訪統計并比較兩組術后并發癥、復發和死亡情況。 結果 兩組手術時間、手術切除直腸長度、腫瘤遠端切緣長度、淋巴結清掃數目、直腸系膜完整度及切緣陰性率比較，差異無統計學意義（P > 0.05）;觀察組術中失血量少于對照組，并發癥發生率低于對照組，肛門排氣時間、住院時間均短于對照組，差異均有統計學意義（P < 0.05）;觀察組手術費用、住院費用顯著低于對照組，差異有統計學意義（P < 0.05）;兩組術后各失訪2例，隨訪時間3個月～2年，且隨訪期間兩組無復發和死亡情況發生。 結論 自制平臺腔鏡下經肛輔助入路TME治療中低位直腸癌與腹腔鏡TME比較，手術時間、手術切除直腸情況相當，但前者具有術中失血量小、術后恢復快、費用低、并發癥少等多種優點，值得推廣。

[關鍵詞] 中低位直腸癌;經肛入路;腹腔鏡;全直腸系膜切除

[中圖分類號] R73? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）06（b）-0109-05

Application of self-made laparoscopic transanal assisted total mesorectal excision in patients with middle and low rectal cancer

WANG Yuncheng? ?ZHAI Gang? ?QIN Chuan

Department of General Surgery， People′s Hospital of Baise， Guangxi Zhuang Autonomous Region， Baise? ?533000， China

[Abstract] Objective To observe the effect of percutaneous transanal assisted total mesorectal excision （TME） in patients with moderate-low rectal cancer. Methods From June 2016 to June 2018， 45 cases of moderate-low rectal cancer patients admitted to the General Surgery People′s Hospital of Baise were selected and divided into two groups by the random number table method. There were 20 patients in the observation group and 25 patients in the control group. The control group was treated with conventional laparoscopic TME， and the observation group was treated with self-made platform laparoscopic transanal approach and transabdominal TME. The surgically related indicators and rectal surgical specimens were compared in the two groups. Treatment-related costs of the two groups were compared. Follow-up statistics and comparison of postoperative complications， recurrences， and deaths were compared and compared in the two groups. Results There was no significant difference in operation time， length of rectum resection， length of distal tumor resection margin， number of lymph node dissection， mesenteric integrity and negative rate of resection margin between the two groups （P > 0.05）. Intraoperative blood loss in the observation group was less than that in the control group， the incidence of complications was lower than that in the control group， and the time of anal exhaust and hospital stay were shorter than that in the control group， with statistically significant differences （P < 0.05）. The costs of operation and hospitalization in the observation group were significantly lower than those in the control group， with statistically significant differences （P < 0.05）. Two cases were lost to follow-up in the two groups， and the follow-up period was 3 months to 2 years. No recurrence or death occurred in the two groups during the follow-up period. Conclusion Compared with laparoscopic TME in the treatment of middle and low rectal cancer under self-made platform endoscopy， TME through anal assisted approach has similar operation time and surgical resection of rectum， but the former has many advantages， such as small intraoperative blood loss， fast postoperative recovery， low cost and few complications， and is worthy of promotion.

[Key words] Moderate-low rectal cancer; Transanal approach; Laparoscopy; Total mesorectal excision

直腸癌是臨床常見惡性腫瘤之一，我國以中低位直腸癌較為常見，約占直腸癌的70%[1]。中低位結腸癌主要治療手段有手術切除、放化療等，其中腹腔鏡全直腸系膜切除術（TME）是中低位直腸癌的主要外科治療手段[2]。臨床實踐發現[3-4]，無論開腹或腹腔鏡TME治療時，在對男性、肥胖或骨盆狹小等中低位直腸癌患者進行直腸遠端游離時較為困難，可能導致直腸系膜切除不完整或切緣陽性，進而增加復發風險。為改善直腸遠端游離困難……