屈景辉, 贺佳蓓, 张琦, 李山晨, 陈殿超, 杨向东. 腹腔镜经括约肌间切除联合回肠预防性造口治疗超低位直肠癌的疗效观察[J]. 中国肿瘤临床, 2019, 46(3): 122-125. DOI: 10.3969/j.issn.1000-8179.2019.03.377
引用本文: 屈景辉, 贺佳蓓, 张琦, 李山晨, 陈殿超, 杨向东. 腹腔镜经括约肌间切除联合回肠预防性造口治疗超低位直肠癌的疗效观察[J]. 中国肿瘤临床, 2019, 46(3): 122-125. DOI: 10.3969/j.issn.1000-8179.2019.03.377
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Jinghui Qu, He Jiabei, Zhang Qi, Li Shanchen, Chen Dianchao, Yang Xiangdong. Clinical observation of laparoscopic abdominoperineal intersphincteric resection combined with ileostomy for treatment of ultra-low rectal cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2019, 46(3): 122-125. DOI: 10.3969/j.issn.1000-8179.2019.03.377
Citation: Jinghui Qu, He Jiabei, Zhang Qi, Li Shanchen, Chen Dianchao, Yang Xiangdong. Clinical observation of laparoscopic abdominoperineal intersphincteric resection combined with ileostomy for treatment of ultra-low rectal cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2019, 46(3): 122-125. DOI: 10.3969/j.issn.1000-8179.2019.03.377
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腹腔镜经括约肌间切除联合回肠预防性造口治疗超低位直肠癌的疗效观察

Clinical observation of laparoscopic abdominoperineal intersphincteric resection combined with ileostomy for treatment of ultra-low rectal cancer

    摘要
  • 摘要:
      目的  观察和评价腹腔镜经括约肌间切除（intersphincteric resection，ISR）联合回肠预防性造口治疗超低位直肠癌的临床疗效。
      方法  回顾性分析2015年1月至2017年6月成都肛肠专科医院收治的74例行腹腔镜超低位直肠癌根治术患者的临床资料，分为接受腹腔镜ISR联合回肠预防性造口组43例（ISR组），接受腹腔镜超低位前切除（low anterior resection，LAR）联合回肠预防性造口组31例（LAR组），比较两组患者围手术期情况、肿瘤根治情况和术后肛门功能。
      结果  两组患者术中出血量、术后住院时间和术后并发症发生率的比较差异无统计学意义（均P>0.05），但ISR组手术时间明显长于LAR组（306.6±25.1）min vs.（239.7± 26.4）min，P=0.010；两组患者术后病理T、N分期的比较差异无统计学意义（均P>0.05），ISR组、LAR组T分期诊断符合率分别为93.0%和93.5%；两组环周切缘阳性率均为0，ISR组远切缘长度明显优于LAR组（2.3±0.1）cm vs.（1.4±0.3）cm，P < 0.001，随访12~42个月，平均23.4个月，ISR组局部复发率明显低于LAR组0 vs. 12.9%（4/31），P=0.027，两组均无远处转移；两组术后肛管直肠测压结果比较差异无统计学意义（均P>0.05），造口还纳后ISR组和LAR组分别有83.7%和87.1%患者排粪控制良好，两组比较差异无统计学意义（P>0.05）。
      结论  腹腔镜ISR联合回肠预防性造口治疗超低位直肠癌安全可行，肛门功能及短期疗效满意。

     

    Abstract:
      Objective  To observe and evaluate the clinical efficacy of laparoscopic abdominoperineal intersphincteric resection combined with ileostomy for the treatment of ultra-low rectal cancer.
      Methods  Clinicopathologic data of 74 patients undergoing laparoscopic radical resection for ultra-low rectal cancer at Coloproctology Hospital of Chengdu from January 2015 to June 2017 were retrospectively analyzed.In total, 43 patients underwent laparoscopic abdominoperineal intersphincteric resection combined with ileostomy (ISR group), and 31 patients underwent laparoscopic low anterior resection combined with ileostomy (LAR group).The perioperative condition, radical resection of tumor, and postoperative anal function were compared between the two groups.
      Results  There were no significant differences in blood loss, postoperative hospital stay, and postoperative complications between the groups (all P> 0.05).The mean operative time was (306.6±25.1) minutes in the ISR group and (239.7±26.4) minutes in the LAR group (P=0.010). There were no significant differences in pT and pN between the groups (all P values >0.05).The coincidence rate of T stage diagnosis was 93.0% in the ISR group and 93.5% in the LAR group.The positive rate of circumferential resection margin in the two groups was 0. The mean distance of the distal margin was (2.3±0.1) cm in the ISR group and (1.4±0.3) cm in the LAR group (P < 0.001).All patients were followed up for 12-42(mean 23.4) months.The local recurrence rate was 0 in the ISR group and 12.9%(4/31) in the LAR group (P=0.027);no distant metastasis was observed in any of the groups.There was no significant difference in the
      Results  of the anorectal manometry test between the groups (P>0.05).The proportion of patients with good continence of anal function after closure of ileos-tomy was 83.7% in the ISR group and 87.1% in the LAR group (P>0.05).
      Conclusions  Laparoscopic abdominoperineal intersphincteric resection combined with ileostomy is safe and feasible for the treatment of ultra-low rectal cancer, and it leads to satisfactory anal function and a short-term curative effect.

     

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