单孔腹腔镜联合折刀位低位直肠癌Miles术与四孔截石位对比分析

目的探讨单孔腹腔镜联合折刀位低位直肠癌Miles术与四孔截石位的疗效对比。方法回顾性分析收治的TNM分期Ⅱ～Ⅲ期的低位直肠癌患者36例，其中19例行截石位下四孔腹腔镜下切除（截石位组），17例行单孔腹腔镜联合折刀位低位直肠癌Miles术（折刀位组）。观察两组患者的手术时间和失血量、术后恢复情况和术后并发症，术后复发率和生存率。结果折刀位组的会阴部操作失血量明显少于截石位组（31．5±22．4）ml比（53．5±25．6）ml]，差异有统计学意义（P=0．01），术后会阴部引流管拔除时间明显早于截石位组（6．7±1．9）d比（9．8±1．7）d]，差异有统计学意义（P〈0．01），而折刀位组和截石位组两组患者的手术时间、腹部操作失血量、手术失血量、术后下床时间、术后排气排便时间、拆线时间、术后住院时间、术后并发症、术后2年肿瘤复发率和生存率比较差异无统计学意义（P〉0．05）。结论单孔腹腔镜联合折刀位低位直肠癌Miles术是安全有效的，可以获得较为满意的微创和美容效果，较四孔截石位Miles术还能减少会阴部术中出血和术后渗液。

The comparative analysis between single-port access laparoscopic Miles surgery with jackknife position and laparoscopic Miles surgery with lithotomy position for low rectal cancer

Objective To investigate the comparative analysis between single-port access laparoscopic Miles surgery with jackknife position and laparoscopic Miles surgery with lithotomy position for low rectal cancer. Methods Retrospectively analyzed 36 patients with low rectal cancer （TNM stage： Ⅱ - Ⅲ） undergoing laparoscopic abdominoperineal excision. Patients were divided into two groups. Lithotomy position group： laparoscopic Miles surgery with lithotomy position. Jackknife position group： single-port access laparoscopic Miles surgery with jackknife position. The operation time, blood loss, postoperative recovery, postoperative complication, postoperative recurrence and survival rate were observed. Results Blood loss of perineal position in jackknife position group was less than that in lithotomy position group （31.5 ± 22.4） ml vs. （53.5 ± 25.6） ml] （P = 0.01 ）, and removal of drainage tube in jackknife position group was earlier than that in lithotomy position group （6.7 ± 1.9 ） d vs. （ 9.8 ± 1.7 ） d ] （P 〈 0.01 ）. However, the operation time , blood loss in abdomen, blood loss , postoperative out-of-bed activity time, recovery of gastrointestinal function time, dermal sutures out time, postoperative hospital stay, complication, postoperative recurrence in 2 years and survival rate between two groups had no significant difference （P 〉 0.05）. Conclusions Single-port access laparoscopic Miles surgery is safe and feasible with better surgical outcome and cosmetic benefits. Furthermore, the blood loss and postoperative exudation at perineal region is less than that in traditional lithotomy position.