保肛术与腹会阴联合直肠癌根治术对低位直肠癌疗效及生活质量的比较研究
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摘要
目的:比较保肛术与腹会阴联合直肠癌根治术(Miles术)对低位直肠癌患者的疗效及生活质量。方法:选取我院于2016年1月至2017年7月期间收治的低位直肠癌患者50例,按照乱数表法分为观察组与对照组,两组均为25例。观察组给予保肛术治疗,对照组给予Miles术治疗。对比两组患者围手术期情况以及术后并发症发生率,采用自制评分量表评价并对比两组患者术后的生活质量,随访1年,比较两组患者的复发率和1年生存率。结果:与对照组比较,观察组术中出血量、术后恢复正常排便时间、术后排气时间以及住院时间均降低(P<0.05);与对照组比较,观察组生活质量优良率明显升高(P<0.05);观察组术后并发症发生率明显低于对照组(P<0.05);观察组盆腔复发率、吻合口复发率低于对照组,而1年生存率高于对照组(P<0.05)。结论:与Miles术比较,保肛术治疗低位直肠癌患者的临床疗效更好,患者术后恢复快、术后并发症发生率低,可明显改善患者的生活质量以及预后,值得临床推广应用。
Objective: To compare the curative effect and quality of life of anus preserving surgery and abdominoperineal radical operation of rectal cancer(Miles surgery) in patients with low rectal cancer. Methods: 50 patients with low rectal cancer who were treated in our hospital from January 2016 to July 2017 were selected, they were were divided into observation group and control group according to the random number table method, and two groups were 25 cases. The observation group was given anus preserving surgery, while the control group was treated with Miles surgery. The condition in perioperative period and the incidence of postoperative complications were compared between the two groups. Self rating scale was used to evaluate and compare the postoperative quality of life of the two groups. The recurrence rate and the 1 year survival rate of the two groups were compared after 1 years of follow-up. Results: Compared with the control group, the amount of bleeding during operation, the time to return to normal defecation, postoperative exhaust time and hospitalization time in the observation group were all decreased(P<0.05). Compared with the control group, the good and excellent rate of quality of life in the observation group was significantly increased(P<0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group(P<0.05). The pelvic recurrence rate and anastomotic recurrence rate of the observation group were lower than those of the control group, and the 1 year survival rate was higher than that of the control group(P<0.05). Conclusions: Compared with Miles surgery, clinical efficacy of anus preserving surgery is better in the treatment of low rectal cancer, postoperative recovery of patients is more quickly, and the incidence of postoperative complications is lower. It can significantly improve the quality of life and prognosis of patients, which is worthy of clinical application.
Objective: To compare the curative effect and quality of life of anus preserving surgery and abdominoperineal radical operation of rectal cancer(Miles surgery) in patients with low rectal cancer. Methods: 50 patients with low rectal cancer who were treated in our hospital from January 2016 to July 2017 were selected, they were were divided into observation group and control group according to the random number table method, and two groups were 25 cases. The observation group was given anus preserving surgery, while the control group was treated with Miles surgery. The condition in perioperative period and the incidence of postoperative complications were compared between the two groups. Self rating scale was used to evaluate and compare the postoperative quality of life of the two groups. The recurrence rate and the 1 year survival rate of the two groups were compared after 1 years of follow-up. Results: Compared with the control group, the amount of bleeding during operation, the time to return to normal defecation, postoperative exhaust time and hospitalization time in the observation group were all decreased(P<0.05). Compared with the control group, the good and excellent rate of quality of life in the observation group was significantly increased(P<0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group(P<0.05). The pelvic recurrence rate and anastomotic recurrence rate of the observation group were lower than those of the control group, and the 1 year survival rate was higher than that of the control group(P<0.05). Conclusions: Compared with Miles surgery, clinical efficacy of anus preserving surgery is better in the treatment of low rectal cancer, postoperative recovery of patients is more quickly, and the incidence of postoperative complications is lower. It can significantly improve the quality of life and prognosis of patients, which is worthy of clinical application.
引文
[1]Chioreso C,Del Vecchio N,Schweizer ML,et al.Association Between Hospital and Surgeon Volume and Rectal Cancer Surgery Outcomes in Patients With Rectal Cancer Treated Since 2000:Systematic Literature Review and Meta-analysis[J].Dis Colon Rectum,2018,61(11):1320-1332
[2]Matsuda K,Yokoyama S,Hotta T,et al.Oncological Outcomes following Rectal Cancer Surgery with High or Low Ligation of the Inferior Mesenteric Artery[J].Gastrointest Tumors,2017,4(1-2):45-52
[3]Yang Z,Chunhua G,Huayan Y,et al.Anatomical basis for the choice of laparoscopic surgery for low rectal cancer through the pelvic imaging data-a cohort study[J].World J Surg Oncol,2018,16(1):199
[4]Kennedy ED,Borowiec AM,Schmocker S,et al.Patient and Physician Preferences for Nonoperative Management for Low Rectal Cancer:Is It a Reasonable Treatment Option?[J].Dis Colon Rectum,2018,61(11):1281-1289
[5]Park IJ,Kim JC.Intersphincteric Resection for Patients With Low-Lying Rectal Cancer:Oncological and Functional Outcomes[J].Ann Coloproctol,2018,34(4):167-174
[6]Yeom SS,Park IJ,Jung SW,et al.Outcomes of patients with abdominoperineal resection(APR)and low anterior resection(LAR)who had very low rectal cancer[J].Medicine(Baltimore),2017,96(43):e8249
[7]Munakata S,Murai Y,Koizumi A,et al.Abdominoperineal Resection for Unexpected Distal Intramural Spreading of Rectal Cancer[J].Case Rep Gastroenterol,2018,12(2):297-302
[8]Trenti L,Galvez A,Biondo S,et al.Quality of life and anterior resection syndrome after surgery for mid to low rectal cancer:A cross-sectional study[J].Eur J Surg Oncol,2018,44(7):1031-1039
[9]Hakoda K,Yoshimitsu M,Emi M,et al.Abdominoperineal Resection for Anal Metastasis of Rectal Cancer[J].Gan To Kagaku Ryoho,2017,44(12):1364-1366
[10]Mak JCK,Foo DCC,Wei R,et al.Sphincter-Preserving Surgery for Low Rectal Cancers:Incidence and Risk Factors for Permanent Stoma[J].World J Surg,2017,41(11):2912-2922
[11]Kye BH,Kim JG,Cho HM,et al.Laparoscopic Abdominal Transanal Proctocolectomy with Coloanal Anastomosis Is a Good Surgical Option in Selective Patients with Low-Lying Rectal Cancer:A Retrospective Analysis Based on a Single Surgeon's Experience[J].J Laparoendosc Adv Surg Tech A,2018,28(3):269-277
[12]Xanthis A,Greenberg D,Jha B,et al.Local recurrence after'standard abdominoperineal resection:do we really need ELAPE?[J].Ann RColl Surg Engl,2018,100(2):111-115
[13]Seshadri RA,West NP,Sundersingh S.A pilot randomized study comparing extralevator with conventional abdominoperineal excision for low rectal cancer after neoadjuvant chemoradiation[J].Colorectal Dis,2017,19(7):O253-O262
[14]来旭,余召师,汤俊,等.关闭盆底腹膜在腹腔镜直肠癌Miles根治术中的意义[J].现代生物医学进展,2015,15(20):3895-3897
[15]Yang Z,Chunhua G,Huayan Y,et al.Anatomical basis for the choice of laparoscopic surgery for low rectal cancer through the pelvic imaging data-a cohort study[J].World J Surg Oncol,2018,16(1):199
[16]Yoo RN,Kim G,Kye BH,et al.The fate of preserved sphincter in rectal cancer patients[J].Int J Colorectal Dis,2018,33(6):745-753
[17]Gómez Fleitas M.From Miles'procedure to robotic transanal proctectomy[J].Cir Esp,2014,92(8):507-509
[18]葛晓明.腹腔镜肛提肌外腹会阴联合切除术治疗低位进展期直肠癌的临床研究[J].贵州医药,2017,41(3):258-260
[19]Tsukamoto S,Miyake M,Shida D,et al.Intersphincteric Resection Has Similar Long-term Oncologic Outcomes Compared with Abdominoperineal Resection for Low Rectal Cancer Without Preoperative Therapy:Results of Propensity Score Analyses[J].Dis Colon Rectum,2018,61(9):1035-1042
[20]路旭,汪大伟,范维,等.经直肠超声在直肠癌术前分期中的应用及进展[J].现代生物医学进展,2017,17(7):1375-1378
[21]Fang JF,Wei B,Zheng ZH,et al.Effect of intra-operative autonomic nerve stimulation on pelvic nerve preservation during radical laparoscopic proctectomy[J].Colorectal Dis,2015,17(12):O268-O276
[22]Wei HB,Fang JF,Zheng ZH,et al.Effect of preservation of Denonvilliers'fascia during laparoscopic resection for mid-low rectal cancer on protection of male urinary and sexual functions[J].Medicine(Baltimore),2016,95(24):e3925
[23]李世拥,陈纲,杜峻峰,等.腹部无切口经肛门切除标本的腹腔镜低位直肠癌根治套入式吻合保肛术[J].中华胃肠外科杂志,2015,18(6):581-583
[24]Uematsu D,Akiyama G,Sugihara T,et al.Transanal Total Pelvic Exenteration With Sphincter-Preserving Surgery[J].Dis Colon Rectum,2018,61(5):641
[25]Liu Z,Kang L,Huang M,et al.Decrease of Sphincter Preserving Length Lowers the Postoperative Genital Function for Patients with Rectal Cancer[J].Surg Laparosc Endosc Percutan Tech,2018,28(1):42-46
[26]Hata T,Takahashi H,Sakai D,et al.Neoadjuvant Cape Ox therapy followed by sphincter-preserving surgery for lower rectal cancer[J].Surg Today,2017,47(11):1372-1377
[27]Matsunaga R,Nishizawa Y,Saito N,et al.Anal Function after Surgery for Low-Lying Rectal Cancer:Comparison of Mechanical and Hand-Sewn Coloanal Anastomosis[J].Dig Surg,2017,34(6):469-475
[28]Koyama M,Kitamura K,Matsumura T,et al.Assessment of Functional Results after Sphincter-Preserving Surgery in Elderly Patients with Low Rectal Cancer[J].Gan To Kagaku Ryoho,2016,43(12):1526-1528
[29]Xiong Y,Huang P,Ren QG.Transanal Pull-Through Procedure with Delayed versus Immediate Coloanal Anastomosis for Anus-Preserving Curative Resection of Lower Rectal Cancer:A Case-Control Study[J].Am Surg,2016,82(6):533-539
[30]Scheele J,Lemke J,Meier M,et al.Quality of Life After SphincterPreserving Rectal Cancer Resection[J].Clin Colorectal Cancer,2015,14(4):e33-e40
[2]Matsuda K,Yokoyama S,Hotta T,et al.Oncological Outcomes following Rectal Cancer Surgery with High or Low Ligation of the Inferior Mesenteric Artery[J].Gastrointest Tumors,2017,4(1-2):45-52
[3]Yang Z,Chunhua G,Huayan Y,et al.Anatomical basis for the choice of laparoscopic surgery for low rectal cancer through the pelvic imaging data-a cohort study[J].World J Surg Oncol,2018,16(1):199
[4]Kennedy ED,Borowiec AM,Schmocker S,et al.Patient and Physician Preferences for Nonoperative Management for Low Rectal Cancer:Is It a Reasonable Treatment Option?[J].Dis Colon Rectum,2018,61(11):1281-1289
[5]Park IJ,Kim JC.Intersphincteric Resection for Patients With Low-Lying Rectal Cancer:Oncological and Functional Outcomes[J].Ann Coloproctol,2018,34(4):167-174
[6]Yeom SS,Park IJ,Jung SW,et al.Outcomes of patients with abdominoperineal resection(APR)and low anterior resection(LAR)who had very low rectal cancer[J].Medicine(Baltimore),2017,96(43):e8249
[7]Munakata S,Murai Y,Koizumi A,et al.Abdominoperineal Resection for Unexpected Distal Intramural Spreading of Rectal Cancer[J].Case Rep Gastroenterol,2018,12(2):297-302
[8]Trenti L,Galvez A,Biondo S,et al.Quality of life and anterior resection syndrome after surgery for mid to low rectal cancer:A cross-sectional study[J].Eur J Surg Oncol,2018,44(7):1031-1039
[9]Hakoda K,Yoshimitsu M,Emi M,et al.Abdominoperineal Resection for Anal Metastasis of Rectal Cancer[J].Gan To Kagaku Ryoho,2017,44(12):1364-1366
[10]Mak JCK,Foo DCC,Wei R,et al.Sphincter-Preserving Surgery for Low Rectal Cancers:Incidence and Risk Factors for Permanent Stoma[J].World J Surg,2017,41(11):2912-2922
[11]Kye BH,Kim JG,Cho HM,et al.Laparoscopic Abdominal Transanal Proctocolectomy with Coloanal Anastomosis Is a Good Surgical Option in Selective Patients with Low-Lying Rectal Cancer:A Retrospective Analysis Based on a Single Surgeon's Experience[J].J Laparoendosc Adv Surg Tech A,2018,28(3):269-277
[12]Xanthis A,Greenberg D,Jha B,et al.Local recurrence after'standard abdominoperineal resection:do we really need ELAPE?[J].Ann RColl Surg Engl,2018,100(2):111-115
[13]Seshadri RA,West NP,Sundersingh S.A pilot randomized study comparing extralevator with conventional abdominoperineal excision for low rectal cancer after neoadjuvant chemoradiation[J].Colorectal Dis,2017,19(7):O253-O262
[14]来旭,余召师,汤俊,等.关闭盆底腹膜在腹腔镜直肠癌Miles根治术中的意义[J].现代生物医学进展,2015,15(20):3895-3897
[15]Yang Z,Chunhua G,Huayan Y,et al.Anatomical basis for the choice of laparoscopic surgery for low rectal cancer through the pelvic imaging data-a cohort study[J].World J Surg Oncol,2018,16(1):199
[16]Yoo RN,Kim G,Kye BH,et al.The fate of preserved sphincter in rectal cancer patients[J].Int J Colorectal Dis,2018,33(6):745-753
[17]Gómez Fleitas M.From Miles'procedure to robotic transanal proctectomy[J].Cir Esp,2014,92(8):507-509
[18]葛晓明.腹腔镜肛提肌外腹会阴联合切除术治疗低位进展期直肠癌的临床研究[J].贵州医药,2017,41(3):258-260
[19]Tsukamoto S,Miyake M,Shida D,et al.Intersphincteric Resection Has Similar Long-term Oncologic Outcomes Compared with Abdominoperineal Resection for Low Rectal Cancer Without Preoperative Therapy:Results of Propensity Score Analyses[J].Dis Colon Rectum,2018,61(9):1035-1042
[20]路旭,汪大伟,范维,等.经直肠超声在直肠癌术前分期中的应用及进展[J].现代生物医学进展,2017,17(7):1375-1378
[21]Fang JF,Wei B,Zheng ZH,et al.Effect of intra-operative autonomic nerve stimulation on pelvic nerve preservation during radical laparoscopic proctectomy[J].Colorectal Dis,2015,17(12):O268-O276
[22]Wei HB,Fang JF,Zheng ZH,et al.Effect of preservation of Denonvilliers'fascia during laparoscopic resection for mid-low rectal cancer on protection of male urinary and sexual functions[J].Medicine(Baltimore),2016,95(24):e3925
[23]李世拥,陈纲,杜峻峰,等.腹部无切口经肛门切除标本的腹腔镜低位直肠癌根治套入式吻合保肛术[J].中华胃肠外科杂志,2015,18(6):581-583
[24]Uematsu D,Akiyama G,Sugihara T,et al.Transanal Total Pelvic Exenteration With Sphincter-Preserving Surgery[J].Dis Colon Rectum,2018,61(5):641
[25]Liu Z,Kang L,Huang M,et al.Decrease of Sphincter Preserving Length Lowers the Postoperative Genital Function for Patients with Rectal Cancer[J].Surg Laparosc Endosc Percutan Tech,2018,28(1):42-46
[26]Hata T,Takahashi H,Sakai D,et al.Neoadjuvant Cape Ox therapy followed by sphincter-preserving surgery for lower rectal cancer[J].Surg Today,2017,47(11):1372-1377
[27]Matsunaga R,Nishizawa Y,Saito N,et al.Anal Function after Surgery for Low-Lying Rectal Cancer:Comparison of Mechanical and Hand-Sewn Coloanal Anastomosis[J].Dig Surg,2017,34(6):469-475
[28]Koyama M,Kitamura K,Matsumura T,et al.Assessment of Functional Results after Sphincter-Preserving Surgery in Elderly Patients with Low Rectal Cancer[J].Gan To Kagaku Ryoho,2016,43(12):1526-1528
[29]Xiong Y,Huang P,Ren QG.Transanal Pull-Through Procedure with Delayed versus Immediate Coloanal Anastomosis for Anus-Preserving Curative Resection of Lower Rectal Cancer:A Case-Control Study[J].Am Surg,2016,82(6):533-539
[30]Scheele J,Lemke J,Meier M,et al.Quality of Life After SphincterPreserving Rectal Cancer Resection[J].Clin Colorectal Cancer,2015,14(4):e33-e40
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