李剑

【摘要】 目的：探讨腹腔镜联合经肛门括约肌间切除术（intersphincteric resection，ISR）在T1、T2期超低位直肠癌患者治疗中的应用效果。方法：选取2017年1月-2018年10月笔者所在医院收治的T1、T2期超低位直肠癌患者137例进行回顧性研究，根据治疗过程术式的不同将其分为腹腔镜组（69例）和对照组（68例），腹腔镜组给予腹腔镜联合ISR治疗，对照组给予开腹ISR治疗。记录两组手术情况、肿瘤相关指标、肛门动力学及肛门功能指标并进行比较。结果：腹腔镜组手术时间、肛门排气时间、肠道功能恢复时间、正常饮食时间及住院时间均短于对照组，中出血量少于对照组，差异均有统计学意义（P<0.05）;两组淋巴结清扫数目、淋巴结阳性数、远切缘长度、术后并发症发生率及随访1年局部复发率、远处转移率、死亡率比较差异均无统计学意义（P>0.05）;术后3个月腹腔镜组最大收缩压、最大静息压、静息向量容积、收缩向量容积、排便频率及排便紧迫感患者占比均高于对照组，排便困难率低于对照组，差异均有统计学意义（P<0.05）。结论：腹腔镜联合ISR治疗T1、T2期超低位直肠癌疗效可靠，可显著改善超低位直肠癌患者肛门动力学及肛门功能，值得在临床进行推广应用。

【关键词】 腹腔镜 经肛门括约肌间切除术 超低位直肠癌 肛门动力学 肛门功能

doi：10.14033/j.cnki.cfmr.2020.21.058 文献标识码 B 文章编号 1674-6805（2020）21-0-03

The Application of Laparoscopic Combined with Intersphincteric Resection in Treatment of T1 and T2 Stage Ultra-low Rectal Cancer/LI Jian. //Chinese and Foreign Medical Research， 2020， 18（21）： -142

[Abstract] Objective： To discuss the application research of laparoscopic combined with intersphincteric resection （ISR） in treatment of T1 and T2 stage ultra-low rectal cancer. Method： A retrospective study was conducted on 137 patients with stage T1 and T2 ultra-low rectal cancer admitted to our hospital from January 2017 to October 2018， the patients were divided into the laparoscopic group （69 cases） and the control group （68 cases） according to the different surgical treatment， the laparoscopic group was given laparoscopic combined with ISR treatment， the control group was given open ISR treatment. The operation situation， tumor-related indexes， anal dynamics and anal function indexes of the two groups were recorded and compared. Result： The operative time， anal exhaust time， intestinal function recovery time， normal diet time and hospital stay time in the laparoscopic group were shorter than those in the control group， and the blood loss was less than that of the control group， the differences were statistically significant （P<0.05）. There were no statistically significant differences in the number of lymph nodes dissected， number of lymph nodes positive， length of distal margin， incidence of postoperative complications， local recurrence， distant metastasis， and mortality between the two groups （P>0.05）. Three months after operation， the maximum systolic pressure， maximum resting pressure， resting vector volume， contraction vector volume， defecation frequency and proportion of patients with urgency in the laparoscopic group were higher than those in the control group， and the defecation difficulty rate was lower than that in the control group， the differences were statistically significant （P<0.05）. Conclusion： Laparoscopy combined with ISR in treatment of T1 and T2 stage ultra-low rectal cancer is reliable， can significantly improve ultra-low rectal cancer patients anal dynamic index and anal function， it is worthy of clinical application.

[Key words] Laparoscopic Intersphincteric resection Ultra-low rectal cancer Analdynamics Anal function

First-authors address： Jianli County Traditional Chinese Medicine Hospital， Jianli 433300， China

直肠癌是目前临床上较为常见的恶性肿瘤，统计数据显示低位直肠癌患者占直肠癌病例总数的70%～80%[1]。近年来保留括约肌功能的术式越来越引起学者们的广泛关注，开腹肛门括约肌间切除术（intersphincteric resection，ISR）手术疗效安全可靠，患者对其保肛和远期疗效均较为满意，是目前较为公认的手术治疗方式[2]。随着近年来微创技术的进一步发展，腹腔镜联合ISR手术在T1、T2期超低位直肠癌治疗方面得到了广泛应用。为此本研究选取2017年1月-2018年10月笔者所在医院收治的T1、T2期超低位直肠癌患者137例作为研究对象，对腹腔镜联合ISR治疗T1、T2期超低位直肠癌的应用效果进行探讨，现汇报如下。……