经肛门内镜微创手术与传统开腹手术治疗直肠癌的效果观察

doi:10.3760/cma.j.issn.1007-1245.2023.09.009

国际医药卫生导报 ›› 2023, Vol. 29 ›› Issue (9): 1218-1222.DOI: 10.3760/cma.j.issn.1007-1245.2023.09.009

经肛门内镜微创手术与传统开腹手术治疗直肠癌的效果观察

彭建亮¹ 孙永安² 杨嘉甫³ 袁之路¹ 张忠宝¹ 梁本甲⁴ 张志敏⁵

¹聊城市第三人民医院普外科，聊城　252000；²聊城市第三人民医院急症科，聊城　252000；³聊城市第三人民医院手术室，聊城　252000；⁴山东第一医科大学附属省立医院胃肠外科，济南　250021；⁵聊城市人民医院新生儿科，聊城　252000

收稿日期:2023-01-16 出版日期:2023-05-01 发布日期:2023-05-22
通讯作者: 张志敏，Email：zzm851020@163.com
基金资助:
国家自然科学基金（81802417）

Effect of transanal endoscopic microsurgery and traditional laparotomy on patients with rectal cancer

Peng Jianliang¹, Sun Yongan², Yang Jiafu³, Yuan Zhilu¹, Zhang Zhongbao¹, Liang Benjia⁴, Zhang Zhimin⁵

¹General Surgery, The Third People's Hospital of Liaocheng, Liaocheng 252000, China; ²Emergency Department, The Third People's Hospital of Liaocheng, Liaocheng 252000, China; ³Operating Room, The Third People's Hospital of Liaocheng, Liaocheng 252000, China; ⁴Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China; ⁵Department of Neonatology, The People's Hospital of Liaocheng, Liaocheng 252000, China

Received:2023-01-16 Online:2023-05-01 Published:2023-05-22
Contact: Zhang Zhimin, Email: zzm851020@163.com
Supported by:
National Natural Science Foundation of China (81802417)

摘要/Abstract

摘要：

目的　探讨经肛门内镜微创手术（TEM）与传统开腹手术治疗直肠癌的效果及对患者术后胃肠功能恢复的影响。方法　本研究为随机对照试验。选择2019年5月至2022年5月在聊城市第三人民医院进行治疗的80例直肠癌患者为研究对象，随机分为观察组和对照组，各40例。观察组男26例，女14例，年龄（49.25±7.63）岁，行TEM治疗；对照组男24例，女16例，年龄（50.63±7.24）岁，行传统开腹手术治疗。比较两组手术各项指标、手术前后胃肠激素［胃动素、胃泌素］水平、术后胃肠功能恢复情况、手术前后肛门功能情况以及并发症发生情况。统计学方法采用独立样本t检验、配对t检验、χ²检验。结果　观察组手术时间［（60.57±11.29）min比（143.35±32.54）min］、出血量［（62.93±15.43）ml比（137.69±36.47）ml］、住院时间［（7.45±1.26）d比（12.37±3.13）d］均优于对照组（均P<0.001），两组淋巴结清扫数量、标本长度比较差异均无统计学意义（均P>0.05）。手术后两组胃动素、胃泌素均低于手术前（均P<0.05），但术后观察组胃动素［（253.16±30.57）ng/L比（219.25±29.52）ng/L］、胃泌素水平［（141.24±11.17）µmol/L比（103.65±10.43）µmol/L］均高于对照组（均P<0.001）。手术后观察组胃肠功能恢复情况均优于对照组（均P<0.001）。手术后，两组大便失禁严重度（Wexner）评分均高于手术前，肛管静息压（ARP）、肛管最大收缩压（MSP）均低于手术前，差异均有统计学意义（均P<0.05）；观察组Wexner评分低于对照组［（7.23±1.56）分比（9.58±1.94）分，t=5.970，P<0.001］，两组ARP、MSP水平比较差异均无统计学意义（均P>0.05）。观察组并发症总发生率低于对照组［5.00%（2/40）比20.00%（8/40）］，两组比较差异有统计学意义（χ²=4.114，P=0.043）。结论　TEM与传统开腹手术均可有效治疗直肠癌，其中TEM对胃肠激素水平影响较小，更利于缩短恢复时间，进一步促进胃肠功能与肛门功能恢复，且术后并发症发生率较低，临床应用价值较高。

关键词:

直肠癌, 经肛门内镜微创手术, 传统开腹手术, 胃肠功能, 肛门功能

Abstract:

Objective　To investigate the effects of transanal endoscopic microsurgery (TEM) and traditional laparotomy on the postoperative recovery of gastrointestinal function in patients with rectal cancer. Methods　It was a randomized controlled trial. A total of 80 patients with rectal cancer treated in The Third People's Hospital of Liaocheng from May 2019 to May 2022 were selected as research objects and were randomly divided into an observation group and a control group, with 40 cases in each group. In the observation group, there were 26 males and 14 females, aged (49.25±7.63) years; in the control group, there were 24 males and 16 females, aged (50.63±7.24) years. The observation group received TEM, and the control group received traditional laparotomy. The surgery related indexes, levels of gastrointestinal hormones (motilin and gastrin) before and after surgery, postoperative gastrointestinal function recovery, anal function before and after surgery, and incidences of complications were compared between the two groups. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The operation time [(60.57±11.29) min vs. (143.35±32.54) min], blood loss [(62.93±15.43) ml vs. (137.69±36.47) ml], and hospital stay [(7.45±1.26) d vs. (12.37±3.13) d] in the observation group were all better than those in the control group (all P<0.001), but there were no statistically significant differences in the number of lymph nodes dissected and length of specimens between the two groups (both P>0.05). The motilin and gastrin levels in both groups after surgery were lower than those before surgery (all P<0.05); the levels of motilin [(253.16±30.57) ng/L vs. (219.25±29.52) ng/L] and gastrin [(141.24±11.17) µmol/L vs. (103.65±10.43) µmol/L] in the observation group were higher than those in the control group (both P<0.001). The recovery of gastrointestinal function in the observation group was better than that in the control group (P<0.001). After surgery, the Wexner scores of fecal incontinence severity of the two groups were higher than those before surgery, the anal canal resting pressure (ARP) and anal canal maximum systolic pressure (MSP) were lower than those before surgery, with statistically significant differences (all P<0.05). The Wexner score of the observation group was lower than that of the control group [(7.23±1.56) points vs. (9.58±1.94) points, t=5.970, P<0.001], and there were no statistically significant differences in the levels of ARP and MSP between the two groups (both P>0.05). The total incidence of complications in the observation group was lower than that in the control group [5.00% (2/40) vs. 20.00% (8/40)], with a statistically significant difference between the two groups (χ²=4.114, P=0.043). Conclusion　Both TEM and traditional laparotomy can effectively treat rectal cancer, among which TEM has little effect on gastrointestinal hormone levels, is more conducive to shorten the recovery time and further promote the recovery of gastrointestinal function and anal function, and has a lower incidence of postoperative complications and high clinical application value.

Key words:

Rectal cancer, Transanal endoscopic microsurgery, Traditional laparotomy, Gastrointestinal function, Anal function

彭建亮孙永安杨嘉甫袁之路张忠宝梁本甲张志敏.

经肛门内镜微创手术与传统开腹手术治疗直肠癌的效果观察 [J]. 国际医药卫生导报, 2023, 29(9): 1218-1222.

Peng Jianliang, Sun Yongan, Yang Jiafu, Yuan Zhilu, Zhang Zhongbao, Liang Benjia, Zhang Zhimin.

Effect of transanal endoscopic microsurgery and traditional laparotomy on patients with rectal cancer [J]. International Medicine and Health Guidance News, 2023, 29(9): 1218-1222.

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经肛门内镜微创手术与传统开腹手术治疗直肠癌的效果观察

Effect of transanal endoscopic microsurgery and traditional laparotomy on patients with rectal cancer

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