腹腔镜手术与开腹内外括约肌间切除术对低位直肠癌患者的疗效分析

目的 研究腹腔镜手术和开腹内外括约肌间切除术(ISR)对低位直肠癌患者的治疗效果.方法 选取120例低位直肠癌患者,根据治疗方式不同分为对照组和观察组,每组60例.对照组患者接受开腹ISR治疗,观察者患者接受腹腔镜手术治疗.比较两组患者手术前后1周的血清学指标(氧化应激指标和肿瘤恶性生物学指标)水平变化、手术相关情况(手术时间、术中出血量、有无预防性造口)、术后恢复情况(首次排气时间、恢复饮食时间、住院时间)、术后并发症的发生情况及5年生存情况,分析治疗效果.结果 术前,两组患者的血清Cor、GSH、E、SOD、VEGF、aFGF、bFGF水平比较,差异均无统计学意义(P﹥0.05);术后,观察组患者的Cor、GSH、E、SOD水平均高于对照组,而VEGF、aFGF、bFGF水平均低于对照组,差异均有统计学意义(P﹤0.05).观察组患者术中出血量、术后首次排气时间、恢复饮食时间、住院时间均明显少于对照组,差异均有统计学意义(P﹤0.01).观察组患者术后并发症的总发生率为15.0%,低于对照组的31.7%,差异有统计学意义(P﹤0.05).随访5年,两组患者的无进展生存、总生存情况比较,差异均无统计学意义(P﹥0.05).结论 低位直肠癌患者无论是采用腹腔镜手术,还是开腹ISR治疗,均可根治性切除肿瘤,两者的长期生存情况无明显差异,但腹腔镜手术具有创伤小、出血少、机体应激反应低、术后并发症发生率低等优势,可以做到微创,且可保留患者的肛门功能,提高生存质量.

Clinical efficacy of laparoscopic surgery versus abdominal intersphincteric resection for lower rectal cancer

Objective To compare the efficacies of laparoscopic surgery and abdominal intersphincteric resection (ISR) for low rectal cancer patients.Method One hundred and twenty patients with low rectal cancer were enrolled and divided into control group (60 cases) and observation group (60 cases),according to the treatment regimens they re-ceived.Patients of control group underwent abdominal ISR,patients of observation group were received laparoscopic sur-gery.The change of serum index (oxidative stress index and tumor malignant index) between before and 1 week after treatments,issues related to the operation (duration of operation,bleeding volume during operation and preventive fistuli-zation or not),postoperative recovery (time of first exhaust,diet postoperatively and hospitalization time),complications and 5-year follow-up results were all collected and compared between two groups.Result Before the treatments,serum levels of Cor、GSH、E、SOD、VEGF、aFGF、bFGF of patients in two groups were with no significant differences (P>0.05),while after treatments compared to the control group,the serum levels of Cor、GSH、E、SOD in the observation group were significantly higher and the serum levels of VEGF、aFGF、bFGF were significantly lower (P<0.05).Compared with the control group,the observation group of patients were with less bleeding,earlier postoperative exhaust and diet,shorter hospitalization time,and the difference was statistically significant (P<0.01).Complications rate of the observation group was 15.0%,which was significantly lower than that of the control group as 31.7% (P<0.05).After 5-year follow-up,there was no difference between groups in progression free survival and total survival (P>0.05).Conclusion Both laparoscop-ic surgery and abdominal ISR in the treatment of low rectal cancer can be radical resection of the tumor,there was no sig-nificant difference in long-term survival rate between the two regimens;but the laparoscopic surgical is a minimally inva-sive way with smaller trauma,less bleeding,lower stress response of the body and less postoperative inflammatory risk,which can keep the anal function of patients.