两种TME术式治疗超低位直肠癌临床疗效及安全性比较

目的研究腹腔镜与开腹两种全直肠系膜切除术(TME)治疗超低位直肠癌临床疗效及安全性。 方法选择2013年1月至2015年12月接受治疗的超低位直肠癌患者110例。用随机数表法分为开腹组和腹腔镜组，每组各55例，采用SPSS21.0进行统计学分析，两组患者的术中术后指标和Wexner评分等用( ±s)表示，组间比较用独立t检验；系膜完整率、并发症发生率和生存率等计数资料用率表示，用χ²检验或Fisher确切概率法，P<0.05表示差异有统计学意义。 结果两组患者的远切端距离和淋巴结清扫数量相近(P>0.05)，腹腔镜组患者的手术时间、腹壁切口长度和术中出血量均少于开腹组，系膜完整率高于开腹组(P<0.05)。腹腔镜组患者的术后肛门排气时间、进食流质食物时间、术后离床时间和住院时间均短于开腹组，术后镇痛需求率较低，差异有统计学意义(P<0.05)。两组患者术后排便困难、排便紧迫感和肛门满意的发生率相近，排便频率和Wexner评分相近，两组患者术后2年生存率差异均无统计学意义(P>0.05)。腹腔镜组并发症发生率为5.5%，开腹组为18.2%，两组患者并发症比较差异有统计学意义(χ²＝4.274, P＝0.039)。 结论腹腔镜TME治疗超低位直肠癌的创伤小，患者术后恢复快，并发症少，且能达到和开腹TME手术相同的根治效果，远期疗效相仿，因此建议超低位直肠癌患者在条件允许的情况下选择腹腔镜TME治疗。

Clinical efficacy and safety of laparoscopic and open TME for ultra low rectal cancer

ObjectiveTo investigate the clinical efficacy and safety of laparoscopic and open TME for ultra low rectal cancer. MethodsFrom January 2013 to December 2015, 110 patients with ultra low rectal cancer who treated in our hospital were enrolled into this study, who were divided randomly into laparotomy group (55 cases) and laparoscopic group (55 cases). Clinical data were analyzed by using statistical software SPSS 21.0. Measurement data such as perioperative indicators and Wexner score were expressed as mean±standard deviation, and independent t test was used for comparison between the groups. Count data, such as membrane integrity rate, postoperative complication rate and survival, were expressed as %, and were examined by using χ² test or Fisher exact test. A P value <0.05 was considered as statistically significant difference. ResultsThe distal margins and harvested lymph nodes were similar in both groups (P>0.05). The operation time, abdominal incision length and intraoperative blood loss in laparoscopic group were less than those in laparotomy group respectively, and the mesangial integrity rate in the laparoscopic group was higher than that in the laparotomy group, with significant difference (P<0.05). Postoperative anal exhaust time, food intake time, postoperative ambulation time and hospital stay in the laparoscopic group were shorter than those in the laparotomy group respectively, while postoperative analgesia demand rate was lower in the laparoscopic group (P<0.05). The incidence of defecation difficulty and urgency and anal satisfaction were similar between two groups. The frequency of defecation and Wexner score were similar. There was no significant difference of 2 year survival rate between two groups (P>0.05). The incidence of complications in the laparoscopy group was 5.5% and 18.2% in the laparotomy group, There were significant difference of complication rate between two groups (χ²=4.274, P=0.039). ConclusionPatients underwent laparoscopic TME for ultra-low rectal cancer could undergo less trauma, faster postoperative recovery, less complications, with the same curative effect and ong-term efficacy as open surgery, It is recommended that patients could selectively choose laparoscopic TME for the treatment of low rectal cancer.