Lap-ISR与Lap-ISR联合经肛下拉套入式吻合在低位直肠癌保肛术中的疗效比较

目的:探讨腹腔镜下括约肌间切除术(Lap-ISR)与Lap-ISR联合经肛下拉套入式吻合在低位直肠癌保肛术中的临床疗效。方法:将我院在2016年06月至2021年01月符合纳入条件并完成Lap-ISR和Lap-ISR联合经肛下拉套入式吻合的低位直肠癌病例进行回顾性总结。评估两组患者的基线资料、围手术期指标、病理学指标、并发症发生率、术后肛门功能 Wexner评分以及术后复发情况。结果:52例纳入本研究并顺利完成手术,其中20例完成Lap-ISR联合经肛下拉套入式吻合；32例完成Lap-ISR。两组患者的一般临床资料及手术时间、术中出血量、清扫淋巴结数量、肿瘤远端切缘距离均无统计学意义(均P＞0.05)。两组间近期总并发症发生率差异无统计学意义(P=0.885)。两组患者术后第3、6个月肛门功能评分差异无统计学意义。两组患者术后无复发生存期差异无统计学意义(HR 1.86,95%CI:0.36~9.67,P=0.462)。结论:与Lap-ISR相比，Lap-ISR联合经肛下拉套入式吻合避免了预防性造口且不增加吻合口漏发生率，是安全可行的。

Comparison of effect of Lap-ISR and Lap-ISR with trans-anal pull-in telescopic anastomosis in anus-preserving operation for low rectal cancer

Objective:To investigate the clinical efficacy of laparoscopic intersphincteric resection (Lap-ISR) and laparoscopic intersphincteric resection with trans-anal pull-in telescopic anastomosis (Lap-ISR-TPTA) in the anal-preserving operation for low rectal cancer.Methods:In this retrospective cohort study,the clinical data of patients who underwent the radical resection of low rectal cancer with Lap-ISR or Lap-ISR-TPTA in our hospital from June 2016 to January 2021 were included.The following observation indicators were obtained and compared:Baseline data,perioperative indicators,pathological indicators,complications,postoperative anal function Wexner score and postoperative recurrence.Results:In this study,52 patients were enrolled and successfully finished surgery.They were divided into two groups based on surgical methods:The Lap-ISR group (32 patients) and the Lap-ISR-TPTA (20 patients).The baseline clinical data,operation time,intraoperative blood loss,number of lymph nodes and distance to inferior resection margin of tumor in two groups had no statistically significant differences (P>0.05).The overall incidence of complications after operation was not significantly different (P=0.885).The Wexner score of anal function between the two groups at 3 and 6 months after surgery had no significant differences (P>0.05).There was no significant difference in postoperative disease-free survival between the two groups (HR 1.86,95%CI:0.36~9.67,P=0.462).Conclusion:During anal-preserving radical resection of low rectal cancer,Lap-ISR-TPTA is safe since it prevents diverting stoma and does not raise the risk of anastomotic leaking.