经肛全直肠系膜切除术与腹腔镜TME治疗直肠癌的临床疗效比较

摘要

目的 比较经肛全直肠系膜切除术(taTME)与腹腔镜TME治疗直肠癌的临床疗效.方法 纳入2015年1月至2016年5月本院60例直肠癌患者作为研究对象,随机分为观察组与对照组,每组各30例.观察组行taTME,对照组行腹腔镜TME.比较两组手术情况、术后恢复情况、并发症发生情况及预后.结果 两组术中无中转开腹病例,观察组术中出血量显著低于对照组(P＜0.05),两组手术时间、术中输血比例及淋巴结清扫数目差异均无统计学意义(均P＞0.05).两组术后肛门首次排气时间和进流质饮食时间差异均无统计学意义(均P＞ 0.05),观察组术后首次下床活动时间、引流管拔管时间、住院时间及镇痛药使用率均显著少于对照组(均P＜ 0.05).观察组术后并发症总发生率显著低于对照组,差异有统计学意义(P＜0.05).随访1年,观察组无进展生存26例,总生存27例,失访1例;对照组无进展生存23例,总生存24例,失访2例.两组总生存率和无进展生存率差异均无统计学意义(Log rank x2=0.779、0.608,P=0.377、0.436).结论 taTME用于直肠癌较腹腔镜TME安全性更高,有助于促进患者术后早期恢复,改善预后,但taTME技术水平要求高,术前需充分准备、熟练操作步骤.%Objective To compare the clinical efficacy of transanal total mesorectal excision (taTME) and laparoscopic TME in the treatment of rectal cancer.Methods 60 patients with rectal cancer who were treated in our hospital from January 2015 to May 2016 were recruited as study subjects and were randomly assigned to the treatment group and control group,with 30 cases in each group.The treatment group received taTME,and the control group laparoscopic TME.Indices related to operation,postoperative recovery,complications and prognosis were compared between the two groups.Results There was no conversion to laparotomy.The intraoperative blood loss in the treatment group was significantly lower than that in the control group (P ＜ 0.05).There was no statistically significant difference in operative duration,intraoperative blood transfusion ratio and lymph node dissection between the two groups (P ＞0.05).Time to postoperative anal exhaust and time to liquid diet did not differ between the two groups (P ＞ 0.05).Time to postoperative ambulation,time to drainage tube extubation,hospitalization duration and analgesic use were less in the treatment group than in the control group (P ＜ 0.05).The total incidence of postoperative complications in the treatment group was significantly lower than that in the control group (P ＜ 0.05).After 1 year of follow-up,in the treatment group,there were 26 patients with no progression,27 patients with total survival and 1 patient lost to follow-up.The control group had no progress in 23 cases,the total survival were 24 cases,and 2 cases were lost.There were no significant difference in the total survival rate and progression-free survival rate between the two groups (Log-rank x2 =0.779,0.608;P =0.377,0.436).Conclusion taTME is safer for rectal cancer than laparoscopy TME,and is helpful to promote early recovery and prognosis.However taTME technology level is more demanding.Preoperative preparation and better skill are needed.