陈腾高　李丽军　卢益芳

[摘要] 目的 探討腹腔镜全直肠系膜切除术对低位直肠癌患者血清胃泌素（GAS）、碱性成纤维细胞生长因子（bFGF）、胃动素（MOT）水平及生活质量的影响。 方法 选择2014年1月～2016年5月东阳市人民医院收治的低位直肠癌92例作为研究对象，随机分为对照组与观察组，各46例。观察组采用腹腔镜全直肠系膜切除术治疗，对照组采用常规开放性手术治疗。比较两组手术情况、术后胃肠动力恢复及肛门功能恢复情况，并评定患者术后生活质量的改善情况。 结果 观察组手术时间长于对照组，切口长度短于对照组，术中出血量少于对照组，术后肛门排气时间、开始进食时间、住院时间均短于对照组（P < 0.05）；观察组吻合口瘘及总并发症发生率均低于对照组（P < 0.05）；术后3 d观察组GAS、MOT高于对照组（P < 0.05）；术后3个月，观察组RMTV高于对照组，Wexner评分低于对照组（P < 0.05）；观察组术后不同时间生活质量评分均高于对照组（P < 0.05）。 结论 腹腔镜全直肠系膜切除术对低位直肠癌患者GAS、MOT影响小，且可提升患者生活质量。

[关键词] 低位直肠癌；腹腔镜全直肠系膜切除术；低位直肠癌；胃肠激素；生活质量

[中图分类号] R734 [文献标识码] A [文章编号] 1673-7210（2018）04（b）-0108-04

[Abstract] Objective To investigate the effect of laparoscopic total mesorectal excision on postoperative serum levels of gastrin （GAS）， basic fibroblast growth factor （bFGF） and motilin （MOT） and quality of life in patients with low rectal cancer. Methods Total of 92 cases with low rectal cancer treated in Dongyang People′s Hospital were selected as research objects， and randomly divided into the control group and the observation group， with 46 cases in each group. The observation group was treated with laparoscopic total mesorectal excision， the control group was treated with conventional open surgery. The surgery situation， postoperative recovery of gastrointestinal motility and anal function recovery， improvement of life quality after operation were compared between the two groups. Results The surgical time of the observation group was longer than that of the control group， while the length of incision， intraoperative blood loss， postoperative anal exhaust time， time of taking food and hospitalization time were shorter or less than those of the control group （P < 0.05）. The incidence of anastomotic fistula and the total incidence of complications in the observation group were lower than those in the control group （P < 0.05）. Three days after surgery， levels of GAS and MOT in the observation group were higher than those in the control group （P < 0.05）. Three months after surgery， RMTV in the observation group was higher than that in the control group， while the Wexner score was lower than that in the control group （P < 0.05）. Quality of life scores of the observation group were higher than those in the control group at different time points after surgery （P < 0.05）. Conclusion Laparoscopic total mesorectal excision has little effect on GAS and MOT in patients with low rectal cancer， and it can improve the quality of life of patients.

[Key words] Low rectal cancer； Laparoscopic total mesorectal excision； Low rectal cancer； Gastrointestinal hormone； Quality of life

直肠癌位置低，深入盆腔，解剖关系复杂，且中下段直肠癌与人体肛管括约肌相邻，手术保留肛门及其功能难度较大[1]。早期常采用括约肌间切除术治疗低位直肠癌，但手术对患者肛肠动力学产生影响，导致术后排便障碍[2]。而近年来，随着腹腔镜技术的推广，低位直肠癌患者保肛率得到明显提升[3-4]。但腹腔镜全直肠系膜切除术对低位直肠癌患者胃肠激素、肛门功能的影响尚存在争议。为明确腹腔镜全直肠系膜切除术在低位直肠癌患者中的临床应用价值，现对92例患者展开了随机对照研究，报道如下：

1 对象与方法

1.1 对象

选择2014年1月～2016年5月东阳市人民医院收治的92例低位直肠癌患者作为研究对象。……