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目的:探讨腹腔镜联合经肛门括约肌间径路超低位直肠癌切除的可行性。方法:回顾2010年1月—2012年6月68例行腹腔镜经肛门括约肌间径路超低位直肠癌根治术患者(腔镜组)与同期行76例开腹经肛门括约肌间径超低位直肠癌根治术患者(开腹组)的临床资料,比较两组临床指标与疗效。结果:144例手术均获成功,腔镜组无中转开腹。与开腹组比较,腔镜组手术时间延长[(243.7±40.4)min vs.(150.5±32.1)min],但术中出血量减少[(103.2±10.5)mL vs.(231.6±23.5)mL]、术后切口感染例数减少(1例vs.8例)、肛门排气时间缩短[(2.5±0.6)d vs.(4.6±0.5)d]、住院天数减少[(10.5±0.4)d vs.(14.6±0.3)d],差异均有统计学意义(均P<0.05);两组扫淋巴结数目、吻合口瘘与肠梗阻发生例数,以及术后1年生存率差异均无统计学意义(均P>0.05)。结论:腹腔镜应用于经肛门括约肌间径路超低位直肠癌手术安全可行,并有微创、术后切口感染少等优点。
Objective: To investigate the feasibility of laparoscopic resection of transanal sphincterotomy path ultra-low rectal cancer. Methods: From January 2010 to June 2012, 68 patients undergoing laparoscopic trans-anal sphincterotomy and ultra-low rectal cancer radical resection (endoscopic group) with 76 patients undergoing open-door transanal sphincteric ultralow rectal cancer Radical surgery patients (laparotomy) clinical data, clinical indicators and efficacy of the two groups were compared. Results: 144 cases were successful in operation, laparotomy group without laparotomy. Compared with the open group, the operation time in the endoscopic group was prolonged (243.7 ± 40.4 min vs. 150.5 ± 32.1 min), but the intraoperative blood loss decreased (103.2 ± 10.5) mL vs. (231.6 ± 23.5) mL (2.5 ± 0.6 d vs. (4.6 ± 0.5) d] and length of hospital stay [(10.5 ± 0.4) d (14.6 ± 0.3) d] (all P <0.05). There was no statistical difference in the number of lymph nodes, the numbers of anastomotic fistulas and intestinal obstruction, and the 1-year survival rates Significance (both P> 0.05). Conclusions: Laparoscopy is safe and feasible for transrectal sphincterotomy with ultra-low rectal cancer, and has the advantages of minimally invasive and minimal incision infection.