经肛拖出式全腹腔镜直肠癌前切除在直肠癌患者中的临床价值*

摘要： 目的??比较经肛拖出式全腹腔镜直肠癌前切除和腹腔镜辅助直肠癌前切除在直肠癌患者中的临床价值。方法?2012年1月-2014年1月前瞻性收集低位直肠癌患者120例，将患者随机分为研究组（n =60）和对照组（n =60）。研究组采用经肛拖出式全腹腔镜直肠癌前切除术治疗，对照组采用腹腔镜辅助直肠癌前切除术。主要观察指标为两组患者术中情况、术后并发症和术后恢复情况。结果?与对照组比较，研究组手术时间明显缩短[（132.32±14.92）vs（154.73±17.65）min，P =0.000]；术后引流量明显减少[（299.93±56.49）vs（365.24±68.94）ml，P =0.000）]；胃肠功能恢复时间明显缩短[（57.42±5.84）vs（61.85±7.40）h，P =0.002]；住院时间明显缩短[（12.54±2.76）vs（14.75±2.10）d，P =0.000]。两组患者术中出血量、淋巴结清扫数目、肺炎、下肢动静脉血管血栓、切口感染、吻合口瘘、肠梗阻、2年复发率和死亡率等差异均无统计学意义（P >0.05）。结论?经肛拖出式全腹腔镜直肠癌前切除术有助于加快患者术后恢复。
Abstract: Objective?To compare the clinical values of laparoscopic surgery and laparoscopic surgery by pull through technique for anterior of rectum in patients with rectal cancer.?Methods?From Jan, 2013 to Jan, 2014, 120 patients with low rectal cancer were prospectively collected. The patients were randomly divided into study group (n = 60) and control group (n = 60). Patients in the study group were treated with laparoscopic surgery by pull through technique for anterior resection of rectum, while patients in the control group were treated with laparoscopic surgery. The primary outcomes were intraoperative situations, postoperative complications and recovery.?Results?When compared with the control group, patients in the study group got a significantly shorter operative duration [(132.32±14.92) vs (154.73±17.65) min, P = 0.000]; a significantly lower postoperative drainage volume [(299.93±56.49) vs (365.24±68.94) ml, P = 0.000]; a significantly shorter gastrointestinal function recovery time [(57.42±5.84) vs (61.85±7.40) h, P = 0.002]; and a significantly less of length of hospital stay [(12.54±2.76) vs (14.75±2.10) d, P = 0.000]. There was no significant difference between the two groups in the amount of bleeding, the number of lymph node dissection, pneumonia, lower extremity arteriovenous thrombosis, incision infection, anastomotic leakage, intestinal obstruction, 2-year recurrence rate and mortality rate (P > 0.05).?Conclusion?laparoscopic surgery by pull through technique for anterior resection of rectum can accelerate postoperative recovery.