经肛门与腹腔镜全直肠系膜切除术治疗低位直肠癌的应用对比研究

目的对比经肛门全直肠系膜切除术（TaTME）与传统腹腔镜全直肠系膜切除术（LaTME）两种术式在低位直肠癌治疗中的病理特征和临床治疗效果。 方法回顾性分析2015年1月至2020年9月中山市人民医院收治的100例低位直肠癌患者，根据治疗方式被分为TaTME组（接受TaTME）和LaTME组（接受LaTME），每组50例。所有手术切除标本均进行组织病理学检查。术后随访1年，统计分析两组相关指标差异：环周切缘阳性率（CRM+）、远端切缘阳性率（DRM+）、淋巴结阳性率，平均手术时间、出血量、住院时间、肠道功能恢复时间，保肛率和吻合口瘘发生率。 结果患者均手术顺利，TaTME组的CRM+、DRM+分别为（10±2）%、（8±4）%，与LaTME组的（8±2）%、（6±1）%相比，差异无统计学意义。TaTME组的淋巴结检测阳性率（80±6）%，高于LaTME组的（60±8）%（P=0.041）。TaTME组的平均手术时间（160±35）min和保肛率（80±10）%，均高于LaTME组的（120±26）min、（40±8）%（P<0.001）。TaTME组术中出血量、住院时间、肠道功能恢复时间均低于LaTME组（P<0.001），术后随访1年TaTME组吻合口瘘发生率低于LaTME组（P=0.043）。 结论TaTME在低位直肠癌患者的治疗中具有显著优势，相对于LaTME可显著提高保肛率，降低并发症的发生。

Comparison of transanal and laparoscopic total mesorectal excision in the treatment of low rectal cancer

ObjectiveTo compare the differences of the pathological features and the clinical-therapeutic effects of transanal total mesorectal excision (TaTME) and traditional laparoscopic total mesorectal excision (LaTME) techniques among low rectal cancer patients. MethodsOne hundred low rectal cancer inpatients treated in Zhongshan People' s Hospital were allocated into two groups randomly according to the treatment types: TaTME group (50 cases, adopted TaTME technique) and LaTME group (50 cases, adopted LaTME technique). All surgical specimens were examined histopathologically. After 1 year follow-up, the relevant indexes between the two groups were statistically analyzed: the positive rate of circumferential margin (CRM+), distal margin (DRM+), and lymph nodes; the average operation time, total blood loss, length of hospital stay, recovery time of intestinal function, rate of anus preservation, and the incidence of anastomotic leakage. ResultsAll operations went successfully. CRM+ and DRM+ in TaTME group and LaTME group were (10±2)% and (8±4)%, (8±2)% and (6±1)%, respectively, with no significant differences. The positive rate of lymph node detection in TaTME group was (80±6)%, which was higher than (60±8)% in LaTME group (P=0.041). The average operation time and anus preserving rate of TaTME group were (160±35) min, (80±10)%, which were higher than (120±26) min and (40±8)% of LaTME group (P<0.001). The total blood loss, length of hospital stay, recovery time of intestinal function and the incidence of anastomotic leakage in TaTME group were lower than those in LaTME group (P<0.05). ConclusionsTaTME has significant advantages in the treatment of low rectal cancer. Compared with LaTME, TaTME can significantly improve the anal preservation rate and reduce the incidence of complications.