闭合式切除术在直肠癌腹腔镜全系膜切除根治术中的应用效果研究

目的评价闭合式切除术（CE）在直肠癌腹腔镜全系膜切除（TME）根治术中的临床应用效果。 方法以潍坊医学院附属寿光市人民医院2011年2月至2014年6月收治的54例原发性直肠癌患者为研究对象，30例为实验组进行CE＋ TME腹腔镜根治术，24例为对照组进行TME腹腔镜根治术。术中均联合动脉灌注化疗。比较两组患者手术时间、术中出血量、淋巴结清扫数目、环周切缘（CRM）阳性比例、术后恢复饮食时间、肛门排气时间、尿管留置时间、住院时间、术后并发症发生比例及术后1年局部复发比例等指标。 结果术中出血量（t=11.775，P<0.001)显著低于TME组，CE＋TME组手术时间（t=2.207，P=0.035）、术后肛门排气时间（t=2.059，P=0.045）、导尿管置留时间（t=2.083，P=0.042）、术后1年内局部复发率（χ²=3.97，P=0.047）显著低于TME组；淋巴结清扫数目显著高于TME组（t=9.613，P<0.001）。 结论CE可显著降低TME术后局部复发率，具有一定的临床应用价值。

Study on the clinical effects of closed excision in laparoscopic total mesorectal excision of rectal cancer

ObjectiveTo evaluate the clinical effects of closed excision (CE) in laparoscopic total mesorectal excision (TME) of rectal cancer. MethodsFifty-four patients with primary rectal cancer were enrolled in this study from February 2011 to June 2014. Thirty patients underwent CE + TME laparoscopic radical surgery and 24 patients were treated with TME laparoscopy radical surgery. All patients received chemotherapy by arterial infusion during surgery. Surgical indicators including the operative time, intraoperative blood loss, number of lymph node dissected, ratio of positive circumferential resection margin, postoperative recovery time, anal exhaust time, catheter retention time, hospitalization time, postoperative complications and the proportion of local recurrence within 1 year after the surgery. ResultsThe intraoperative blood loss of CE + TME group were significantly lower than those of TME group (t=11.775, P<0.001). The operation time (t=2.207, P=0.035), postoperative anal exhaust time (t=2.059, P=0.045), catheter retention time (t=2.083, P=0.042) and the proportion of local recurrence (P=0.047) of CE + TME group were also significantly lower than those of TME group. The lymph node dissected (t=9.613, P<0.001) of CE+ TME group was significantly higher than that of TME group (P<0.01). ConclusionCE can significantly reduce the local recurrence rate of TME, and has potent clinical application value.