微创医学

目的分析腹腔镜辅助括约肌间切除（ISR）超低位直肠癌保肛手术的可行性和安全性。方法选取36例行腹腔镜ISR术和38例行开腹ISR术的超低位直肠癌患者，比较两组患者手术时间、术中出血量、正常饮食时间、肛门排气时间、并发症及住院时间、淋巴结清扫数目、远切缘长度、环周切缘阳性率及局部复发、远处转移、死亡率及肛门功能等。结果腹腔镜组术中出血量、正常饮食时间及住院时间均优于开腹组，手术时间长于开腹组，差异均有统计学意义（P＜0.05）；两组术后并发症发生率比较差异无统计学意义（P＞0.05）；两组淋巴结清扫数目、远切缘长度、环周切缘阳性率及局部复发、远处转移、死亡等差异无统计学意义（P＞0.05）；两组排便频率、排便紧迫感、排便困难、Wexner评分比较差异无统计学意义（P＞0.05）。结论腹腔镜辅助ISR超低位直肠癌保肛手术具有较高的可行性和安全性，值得临床深入研究。

ObjectiveTo analyze the feasibility and safety of laparoscopic intersphincteric resection(ISR)for patients with ultra low rectal cancer. MethodsThirtysix patients accepting laparoscopic ISR surgery(laparoscopic group) and 38 cases accepting routine abdominal ISR surgery(laparotomy group) were chosen. The operative time, blood loss, normal diet time, anal exhaust time, complications, hospitalization time, the number of lymph node dissection, cutting edge length, circumferential margin positive rate, local recurrence, distant metastasis, mortality, and anal function were compared between the two groups. ResultsLaparoscopic group was sup erior to the laparotomy group in blood loss, normal diet time, and length of stay (all P＜0.05) ,with a longer operative time than the laparotomy group(P＜0.05). There was no significant difference between the two groups in incidence of postoperative complications (P＞0.05). No significant difference in the number of lymph node dissection, cutting edge length, circumferential margin positive rate, local recurrence, distant metastasis, or mortality between the two groups existed (P＞0.05), neither in the stool frequency, defecation urgency, bowel problems, or Wexner score (P ＞0.05). ConclusionsThe laparoscopic intersphincteric resection for patients with ultra low rectal cancer is of feasibility and safety and worthy of further clinical study