腹腔镜括约肌间切除吻合术（Intersphincteric resection，ISR）在超低位直肠癌保肛术中的应用

发布时间：2018-01-28 04:09

本文关键词： 直肠肿瘤超低位腹腔镜经括约肌间切除术肛肠动力学　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨腹腔镜下全直肠系膜切术联合括约肌间切除吻合术治疗T1和T2期超低位直肠癌的可行性及术后肛肠动力学的变化。方法:回顾性分析了2010-2015年间于我院实施腹腔镜下ISR术22例,开腹行ISR术21例,以及同期超低位直肠癌行腹腔镜下行Dixon术患者20例,通过分别比较腹腔镜下ISR术与开腹ISR术患者手术用时、术中出血、住院时间、主要术后并发症肛门疼痛、吻合口瘘的发生情况、术后3个月及12个月Wexner评分及肛管静息压(ARP)、肛管最大收缩压(MSP)、直肠最大容量(MTV)结果;以及比较腹腔镜下ISR术与腹腔镜下Dixon术患者术后3个月及12个月Wexner评分及肛管静息压(APR)、直肠最大收缩压(MSP)、直肠最大容量(MTV),从而对ISR在腹腔镜超低位直肠癌根治术的安全性及可行性进行论证。结果:腹腔镜ISR组患者手术时间(344±47)长于开腹ISR组(221±19min),术中出血量(124±55ml)少于开腹组(210±95ml)和住院时间(11.0±2.6天)低于开腹组(13.5±3.7天)(P0.05),其主要术后的吻合口瘘概率未见明显差异(P0.05),腹腔镜ISR组术后出现肛门疼痛的情况少于开腹ISR组(P0.05),术后3及12个月Wexner评分及ARP、MSP、MTV比较果差异不显著(P0.05)。腹腔镜下ISR组患者与腹腔镜下Dixon组术后3个月时Wexner肛门功能评分[(4.3±1.8)分比(2.0±1.2)分]ARP[(29.8±4.8)mm Hg比(41.6±6.7)mm Hg]MSP[(105.6±15.9)mm Hg比(119.1±19.0)mm Hg],MTV[(102.4±15.0)mm Hg比(117.7±19.3)mm Hg]明显低于腹腔镜Dixon组,两组患者1年后的各项指标均无统计学差异?结论:1.腹腔镜下ISR术较开腹ISR术术中出血少,住院时间短,短期效果疗效好,两者术后患者排便情况及肛门测压结果没有明显差异。2.腹腔镜下ISR术后肛门功能短期效果较腹腔镜Dixon术后差,但是两者再1年后功能恢复到相同水平,但差于术前。
[Abstract]:Objective: to investigate the feasibility of laparoscopic total mesorectal resection combined with sphincterotomy and anastomosis in the treatment of stage T1 and T2 ultralow rectal cancer and the changes of postoperative anorectal dynamics. A retrospective analysis of 22 cases of laparoscopic ISR was performed in our hospital from 2010 to 2015. ISR was performed in 21 patients and Dixon was performed in 20 patients with ultralow rectal cancer at the same time. The operative time of ISR under laparoscope and open ISR were compared respectively. Intraoperative bleeding, hospital stay, major postoperative complications, anal pain, anastomotic fistula, Wexner score and anal resting pressure at 3 and 12 months after operation. The results of maximum systolic pressure of anal canal (MSPN) and maximal volume of rectum (MTV); The Wexner score and anal resting pressure were compared between laparoscopic ISR and laparoscopic Dixon at 3 and 12 months postoperatively, and the rectal maximum systolic pressure (MPP) was also compared. Maximum rectal volume (MTV). The safety and feasibility of ISR in laparoscopic radical resection of ultralow rectal cancer were demonstrated. Results: the operative time of laparoscopic ISR group was 344 卤47 longer than that of open ISR group (P < 0.05). (221 卤19 min). The intraoperative bleeding volume (124 卤55ml) was lower than that in the open group (210 卤95ml) and the hospitalization time (11.0 卤2.6 days), which was lower than that in the open group (13.5 卤3.7 days) (P 0.05). There was no significant difference in the probability of anastomotic leakage after operation (P 0.05). The incidence of anal pain in the laparoscopic ISR group was less than that in the open ISR group (P 0.05). After 3 and 12 months, Wexner score and ARP MSPM were observed. There was no significant difference in the comparison between MTV and Dixon. Wexner anal function score of patients with Laparoscopic ISR and Laparoscopic Dixon at 3 months after Operation. [The score was 4.3 卤1.8 vs 2.0 卤1.2]? ARP. [29.8 卤4.8 mm Hg vs 41.6 卤6.7 mm Hg]? MSP. [105.6 卤15.9 mm Hg vs 119.1 卤19.0 mm Hg] MTV. [102.4 卤15.0 mm Hg was significantly lower than 117.7 卤19.3 mm Hg in Dixon group, and there was no statistical difference between the two groups after one year. Conclusion 1.Laparoscopic ISR has less bleeding, shorter hospital stay and better short-term effect than open ISR. There was no significant difference in defecation and anus manometry between the two groups. 2. The short-term effect of laparoscopic ISR on anal function was worse than that of laparoscopic Dixon. But the function returned to the same level one year later, but it was worse than that before operation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37

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