腹腔镜经括约肌间切除术对低位直肠癌患者肛门功能及预后的影响

目的探讨腹腔镜经括约肌间切除术治疗低位直肠癌效果,及其对患者肛门功能及预后的影响。方法随机数表法将92例低位直肠癌患者分为对照组和观察组,各46例。对照组患者接受传统开腹手术,观察组患者接受腹腔镜经括约肌间切除术,比较两组患者手术相关指标、肛门直肠指标、肛门失禁量表(Wexner)评分及并发症发生情况。结果观察组患者术中出血量明显少于对照组患者,手术时间、肛门排气时间和住院时间均明显短于对照组患者,差异均有统计学意义(P﹤0.01)。术后3个月,两组患者排粪频率均高于本组术前,肛管静息压(ARP)、直肠最大耐受容量(RMTV)和肛管最大收缩压(AMSP)均低于本组术前,且观察组患者术后排粪频率高于对照组患者,ARP、RMTV和AMSP均低于对照组患者,差异均有统计学意义(P﹤0.05)。术后3、6个月,观察组患者Wexner评分均低于对照组患者,术后3、6、12个月,两组患者Wexner评分均高于本组术前,差异均有统计学意义(P﹤0.05)。观察组患者术后并发症总发生率为10.87%(5/46),低于对照组患者的28.26%(13/46),差异有统计学意义(χ2=4.420,P﹤0.05)。结论腹腔镜经括约肌间切除术治疗低位直肠癌效果显著,可有效改善患者近期肛门功能,缩短术后恢复时间,改善患者预后。

Effect of laparoscopic intersphincteric resection on the anal function and prognosis in patients with low rectal cancer

Objective To investigate the effects of laparoscopic intersphincteric resections on the anal function and prognosis in patients with low rectal cancer.Method A random number table was used to randomize 92 cases with low rectal cancer into control group or study group,with 46 cases in each.The patients in control group were treated with conventional open surgery,while those in study group were treated with laparoscopic intersphincteric resection for low rectal cancer.The surgical indicators,anorectal measures,anal incontinence scale(Wexner)score and incidence of complications were compared between the two groups.Result The volume of blood loss was less,and the operative time,anal exhaust time and hospitalization time were shorter in study group than in control group(P<0.01).Increased frequency of bowel movements were observed in both groups at 3 months after surgery,anal resting pressure(ARP),rectal maximum tolerable(RMTV)and anal maximum squeeze pressure(AMSP)were decreased,furthermore,the study group patients had significantly more bowel movements and lower ARP,RMTV and AMSP compared to those in control group(P<0.05).The Wexner scores of study group were lower than that of the control group at 3 and 6 months after operation,and the Wexner scores were consistently improved in both groups at 3,6 and 12 months after operation,with statistically significant differences noted(P<0.05).The overall incidence of postoperative complications in study group was 10.87%(5/46),which was lower than 28.26%(13/46)in the control group(χ2=4.420,P<0.05).Conclusion Laparoscopic intersphincteric resection of low rectal cancer confers effectively improvement on the anal function of patients,with shortened postoperative recovery time,and improved prognosis.