两种入路腹腔镜下低位直肠腺癌远端直肠离断的效果比较

Comparison of laparoscopic distal rectal amputation in low rectal adenocarcinoma by two approaches

摘要:

目的 比较两种入路腹腔镜下低位直肠腺癌远端直肠离断的效果。方法 选取2019年1月－2022年1月该院收治的80例直肠腺癌患者作为研究对象，采用随机数表法分为A组和B组，各40例，A组采用经闭孔神经前入路远端直肠离断的直肠癌根治术，B组采用腹腔镜辅助经肛门全直肠系膜切除术（TME），比较两组患者的临床疗效。结果 A组术中出血量少于B组，拔出导尿管时间短于B组（P < 0.05）；术后两组患者血清胃动素和胃泌素水平均较术前降低，且A组低于B组（P < 0.05）。A组术后并发症Clavien-Dindo分级为Ⅰ级的多于B组，术后肛门功能（Kirwan分级）优于B组，两组患者比较，差异均有统计学意义（P < 0.05）。结论 采用经闭孔神经前入路远端直肠离断的直肠癌根治术治疗直肠腺癌，可减少术中出血量，缩短术后拔除导尿管时间，促进胃肠动力，保留肛门功能，减轻术后并发症严重程度。

Abstract:

Objective To compare the effect of laparoscopic distal rectectomy for low rectal adenocarcinoma by two different approaches.Methods 80 patients with rectal adenocarcinoma from January 2019 to January 2022 were selected as the research objects, and they were randomly divided into group A and group B, 40 patients in each group. Group A adopted radical resection of rectal cancer by distal rectal disconnection via anterior obturator nerve approach, and group B adopted laparoscopic assisted total rectal mesorectal excision (TME). The clinical effects were compared.Results The amount of intraoperative bleeding and the time of catheter removal in group A were lower than those in group B (P < 0.05); The serum motilin and gastrin levels in both groups were lower than those before surgery, but group A was lower than group B (P < 0.05). The incidence of Clavien-Dindo grade Ⅰ postoperative complications in group A was more than that in group B; The Kirwan grading of anal function in group A was better than that in group B (P < 0.05).Conclusion Radical resection of rectal cancer by distal rectectomy via anterior obturator nerve approach can reduce the amount of bleeding during operation and the time of catheter removal after operation, improve gastrointestinal motility and anal function, and reduce the degree of postoperative complications.