腹腔镜辅助经肛全直肠系膜切除术治疗下段直肠癌疗效分析

doi:10.3969/j.issn.1009-976X.2021.06.007

摘要/Abstract

摘要： 目的探讨腹腔镜辅助经肛全直肠系膜切除术治疗下段直肠癌的经验。方法回顾性分析2017年1月至2020年6月间收治的48例腹腔镜辅助经肛全直肠系膜切除术的患者临床资料（A组）,并与同期186例腹腔镜全直肠系膜切除术进行对比分析（B组）。结果两组病人之间年龄、性别比例、肿瘤最大横径、术中出血量、收获淋巴结个数、术后并发症、术前Wexner评分、术前肛门最大收缩压、术后Wexner评分、术后肛门最大收缩压的差异无统计学意义（P>0.05）。两组病人之间肿瘤下缘至齿线距离、体质指数、手术时间的差异有统计学意义（P<0.05）。在A组内,男性患者和女性患者之间年龄、肿瘤最大横径、新辅助放化疗比例、术中出血量、收获淋巴结、术后并发症比例的差异无统计学意义（P>0.05）,但肿瘤下缘距齿线距离、BMI、手术时间的差异有统计学意义（P<0.05）。结论腹腔镜辅助经肛全直肠系膜切除术治疗下段直肠癌是有效的,尤其适合于低位、骨盆狭窄的男性直肠癌患者,但要充分准备,有序开展。

关键词: 经肛全直肠系膜切除术, 直肠癌, 腹腔镜

Abstract: Objective To explore the preliminary experience of laparoscopic assisted transanal total mesorectal excision in the treatment of lower rectal cancer. Methods The clinical data of 48 patients with laparoscopic assisted transanal total mesorectal excision from January 2017 to June 2020 were retrospectively analyzed （group A）, and compared with 186 patients with laparoscopic total mesorectal excision in the same period （group B）. Results There were no statistically significant differences in age, sex ratio, mean maximum tumor diameter, mean intraoperative blood loss, mean number of harvested lymph nodes, postoperative complications, preoperative Wexner score, preoperative anal maximum systolic pressure, postoperative Wexner score and postoperative anal maximum systolic pressure between group A and B （P>0.05）. However, there were significant differences between the two groups in the average distance from the lower edge of the tumor to the dental line, the average body mass index, and the average operation time （P<0.05）. In group A, there was no significant difference in age, maximum diameter of tumor, proportion of neoadjuvant radiotherapy and chemotherapy, blood loss during operation, lymph nodes harvested and postoperative complications （P>0.05）, but the difference between the distance between the lower margin of tumor and the dental line, BMI and operation time was statistically significant （P<0.05）. Conclusions Laparoscopic assisted transanal total mesorectal excision is effective in the treatment of lower rectal cancer, especially for male patients with low rectal cancer and pelvic stenosis, but it should be fully prepared and carried out orderly.

Key words: transanal total mesorectal excision, rectal cancer, laparoscopy

中图分类号:

R735.3+7

邓建中, 杨平, 计勇, 邱磊, 林梓阳, 余思. 腹腔镜辅助经肛全直肠系膜切除术治疗下段直肠癌疗效分析[J]. 岭南现代临床外科, 2021, 21(06): 625-630.

DENG Jian-zhong, YANG Ping, JI Yong, QIU Lei, LIN Zi-yang, YU Si. Laparoscopic assisted transanal total mesorectal excision for lower rectal cancer： an analysis of 48 cases[J]. Lingnan Modern Clinics In Surgery, 2021, 21(06): 625-630.

参考文献

[1] Sylla P, Rattner DW, Delgado S, et al.NOTES transanalrectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance[J]. Surg Endosc, 2010, 24(5):1205-1210.
[2] Atallah S, Albert M, DeBeche-Adams T, et al. Transanalminimally invasive surgery fortotalmesorectalexcision (TAMIS-TME): a stepwise description of the surgical technique with video demonstration[J]. Tech Coloproctol, 2013, 17(3):321-325.
[3] 陈远光,胡明,雷建,等. 经肛内镜全直肠系膜切除治疗直肠癌[J]. 中国内镜杂志,2010, 16(12): 1261-1265.
[4] 张浩,张云生,金雄伟,等. 完全经肛单孔腹腔镜全直肠系膜切除术治疗直肠癌[J].中国内镜杂志,2012, 18(4): 79-383.
[5] 姚宏伟,张忠涛.中国直肠癌经肛全直肠系膜切除术病例登记数据库的建设与维护[J]. 中华消化外科杂志,2019,18(8): 722-725.
[6] 邓建中,彭翔,余思,等. 腹腔镜全直肠系膜切除术在低位直肠癌的应用(附387例临床分析)[J]. 消化肿瘤杂志(电子版),2010,2(3):153-157.
[7] Vignali A, Elmore U, Milone M, Rosati R.Transanal total mesorectal excision (TaTME): current status and future perspectives[J]. Updates Surg, 2019,71(1):29-37.
[8] Velthuis S, Nieuwenhuis DH, Ruijter TE, et al.Transanalversus traditional laparoscopictotalmesorectalexcision for rectal carcinoma[J]. Surg Endosc, 2014, 28(12):3494-3499.
[9] Simo V, Tejedor P, Jimenez LM, et al.Oncological safety of transanal total mesorectal excision (TaTME) for rectal cancer: mid-term results of a prospective multicentre study[J]. Surg Endosc, 2021, 35(4):1808-1819.
[10] Veltcamp Helbach M, van Oostendorp SE, Koedam TWA, et al. Structured training pathway and proctoring; multicenter results of the implementation of transanal total mesorectal excision (TaTME) in the Netherlands[J]. Surg Endosc, 2020, 34(14):192-201.
[11] Telem DA, Han KS, Kim MC, et al.Transanal rectosigmoid resetion via natural orifice transluminal endoscopic surgery (NOTES) with total mesorectal excision in a large human cadaver series[J]. Surg Endosc, 2013, 27(1):74-80.
[12] Penna M,Hompes R,Arnold S,et al.Incidence and risk factorsfor anastomotic failure in 1594 patients treated by transanal total mesorectal excision:results from the International TaTME Registry[J]. Ann Surg,2019,269(4):700-711.
[13] Ma B, Gao P, Song Y, et al.Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision[J]. BMC Cancer, 2016, 16:380.
[14] van der Heijden JAG, Koëter T, Smits LJH, et al. Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis[J]. Br J Surg, 2020, 107(5):489-498.
[15] 2017 European Society of Coloproctology (ESCP) collaborating group. An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME)[J]. Colorectal Dis, 2018, 20(Suppl 6):33-46.
[16] 中华医学会外科学分会结直肠外科学组,中华医学会外科学分会腹腔镜与内镜学组.直肠癌经肛全直肠系膜切除专家共识及手术操作指南(2017)[J]. 中国实用外科杂志, 2017, 37(9): 978-984.