经肛门全直肠系膜切除和腹腔镜全直肠系膜切除对直肠癌的疗效对比

目的分析比较经肛门全直肠系膜切除（TaTME）与腹腔镜全直肠系膜切除（LaTME）在中低位直肠癌治疗中的疗效及预后。 方法选择东营市东营区人民医院2015年2月至2016年2月收治的64例择期行全直肠系膜切除术（TME）的中低位直肠癌患者,随机分为TaTME组与LaTME组,各32例。观察并比较两组患者的手术时间、术中出血量、标本完整率、环周切缘（CRM）阳性率、远端切缘（DRM）阴性率、淋巴结清扫数目、保肛率、中转开放手术率、术中及术后并发症、术后住院时间、局部复发率、远处转移率、2年总体生存率（OS）各指标间的差异。 结果TaTME组患者的术中出血量、中转开放手术率、手术时间、标本完整率、CRM阳性率、保肛率、术后住院时间、尿潴留发生率均显著优于LaTME组（均P<0.05）。患者均获随访2~24个月,TaTME组中位生存时间为23.9个月,局部复发率、转移率分别为6.2%（2/32）、3.1%（1/32）。LaTME组中位生存时间为19.7个月,局部复发率、转移率均为3.1%（1/32）。两组术后复发率、转移率比较,差异无统计学意义（χ²=0.350、0.516,P=0.554、0.472）。TaTME组与LaTME组1年OS分别为100.00%、93.75%,2年OS分别为96.87%、81.25%。两组1年OS比较,差异无统计学意义（χ²=0.516,P=0.472）,TaTME组的2年OS显著高于LaTME组患者（χ²=4.402,P=0.036）。 结论与LaTME术相比,TaTME术治疗中低位直肠癌具有较高的安全性和有效性,且术后并发症较少,术后住院时间短,可以改善患者预后。

Comparison of transanal total mesorectal excision and laparoscopic total mesorectal excision for rectal cancer

ObjectiveTo analyze the efficacy and prognosis of transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LaTME) in the treatment of middle and lower rectal cancer. MethodsFrom February 2015 to February 2016, sixty-four patients with moderate to low rectal cancer undergoing elective TME were selected and randomly divided into two groups: TaTME group and LaTME group, with 32 cases in each group. The following indexes such as the operation time, intraoperative blood loss, specimen integrity rate, circumferential resection margin (CRM) positive rate, distal resection margin (DRM) negative rate, lymph node dissection, retention rate, conversion rate, intraoperative complications, postoperative complications, postoperative hospital stay, local recurrence rate, distant metastasis rate, and 2-year overall survival rate (OS) were compared between the two groups. ResultsThe intraoperative bleeding, operation time, postoperative hospital stay, and rate of conversion, specimen integrity, positive CRM, anal preservation, urinary retention in TaTME group were significantly better than those in LaTME group (all P<0.05). All patients were followed up for 2-24 months. The median survival time was 23.9 months in TaTME group and 19.7 months in LaTME group. There were no significant differences between the two groups in the local recurrence rate and metastasis rate (6.2% vs 3.1%, χ²=0.350, P=0.554; 3.1% vs 3.1%, χ²=0.516, P=0.472). The local recurrence rate and metastasis rate were 6.2% (2/32) and 3.1%(1/32), respectively. No significant difference was found between the two groups in the 1 year OS (100.00% vs 93.75%, χ²=0.516, P=0.472). The 2-year OS of TaTME group was significantly higher than that of LaTME group (96.87% vs 81.25%, χ²=4.402, P=0.036). ConclusionCompared with LaTME, TaTME has the advantages of less postoperative complications, shorter postoperative hospital stay and better prognosis, and is safe and feasible in the treatment of middle and lower rectal cancer.