腹腔镜关闭盆底腹膜的腹会阴联合切除术治疗低位直肠癌的安全性及近期疗效

Safety and short-term outcomes of laparoscopic abdominoperineal resection with pelvic peritoneum closure for low rectal cancer

    摘要
  • 摘要: 目的:探讨腹腔镜关闭盆底腹膜的腹会阴联合切除术(LARP-PPC)治疗低位直肠癌的安全性及近期疗效。
    方法:采用回顾性队列研究方法。收集2014年1月至2017年12月上海交通大学医学院附属瑞金医院收治132例低位直肠癌患者的临床病理资料；男81例，女51例；平均年龄为62岁，年龄范围为45～83岁。132例患者中，60例行LARP-PPC，设为LARP-PPC组；72例行传统腹腔镜腹会阴联合切除术(LARP)，设为LARP组。观察指标：(1)手术及术后情况。(2)术后病理学检查情况。(3)术后并发症情况。正态分布的计量资料以Mean±SD表示，组间比较采用t检验。偏态分布的计量资料以M(范围)表示，组间比较采用Mann-Whitney U检验。计数资料以绝对数表示，组间比较采用x2检验或Fisher确切概率法。等级资料组间比较采用Mann-Whitney U检验。
    结果:(1)手术及术后情况：两组患者均顺利完成手术，无中转开腹。LARP-PPC组患者手术时间、术中出血量、术后首次肛门排气时间、术后首次饮水时间分别为(163±45)min、168 mL(85～280 mL)、2 d(1～5 d)、3 d(2～6 d)；LARP组患者上述指标分别为(155±39)min、160 mL(100～305 mL)、3 d(1～7 d)、4 d(2～7 d)，两组患者上述指标比较，差异均无统计学意义 (t=1.113，Z=-1.623，-1.468，-0.321，P>0.05)。LARP-PPC组和LARP组患者术后住院时间分别为16 d (11～21 d)和19 d(14～24 d)，两组比较，差异有统计学意义(Z=-5.888，P<0.05)。LARP-PPC组患者关闭盆底腹膜时间为(13±3)min。(2)术后病理学检查情况：LARP-PPC组患者标本长度，淋巴结清扫数目，肿瘤直径，肿瘤高分化、中分化、低分化分别为(18±4)cm，(16±5)枚，(3.7±1.4)cm，10、34、16例；LARP组患者上述指标分别为(18±4)cm，(16±5)枚，(3.9±1.5)cm，13、41、18例，两组患者上述指标比较，差异均无统计学意义(t=0.779，0.390，0.703，Z=-0.267，P>0.05)。(3)术后并发症情况：LARP-PPC组患者术后发生会阴切口感染、会阴切口延迟愈合分别为2例、1例；LARP组患者上述指标分别为12例、10例，两组患者上述指标比较，差异均有统计学意义(x2=6.137，6.400，P<0.05)。LARP-PPC组患者术后发生肠梗阻、会阴疝分别为1例、0； LARP组患者上述指标为8例、6例，两组患者上述指标比较，差异均有统计学意义(P<0.05)。LARP-PPC组和LARP组患者发生术后尿路感染分别为2例和4例，两组比较，差异无统计学意义(P>0.05)。
    结论:LARP-PPC治疗低位直肠癌安全、可行，能显著降低患者术后会阴相关并发症发生率及减少住院时间。

     

    Abstract: Objective:To investigate the safety and shortterm outcomes of laparoscopic abdominoperineal resection with pelvic peritoneum closure (LARP-PPC) for low rectal cancer.
    Methods:The retrospective cohort study was conducted. The clinicopathological data of 132 patients with low rectal cancer who were admitted to Ruijin Hospital of Shanghai JiaoTong University School of Medicine from January 2014 to December 2017 were collected. There were 81 males and 51 females, aged from 45 to 83 years, with an average age of 62 years. Among the 132 patients, 60 undergoing LARP-PPC were allocated into LARP-PPC group, and 72 patients undergoing conventional LARP were allocated into LARP group. All the patients received standardized preoperative and postoperative treatments. Observation indicators: (1) surgical and postoperative conditions; (2) postoperative pathological examination; (3) postoperative complications. The measurement data with normal distribution were expressed as Mean±SD, and the t test was used for comparison between groups. The measurement data with skewed distribution were expressed as M (range), and the Mann-Whitney U test was used for comparison between groups. The count data were expressed as absolute numbers, and the chisquare test or the Fisher exact probability was used for comparison between groups. Mann-Whitney U test was used for comparison of ordinal data between groups.
    Results:(1) Surgery and postoperative conditions: all the patients in the two groups underwent successful surgery without conversion to open surgery. The operation time, volume of intraoperative blood loss, time to first flatus, and time to first liquid intake of the LARP-PPC group were (163±45) minutes, 168 mL(range, 85- 280 mL), 2 days(range, 1-5 days), 3 days(range, 2-6 days), versus (155±39) minutes, 160 mL(range, 100-305 mL), 3 days(range, 1-7 days), 4 days(range, 2-7 days) of the LARP group; there was no difference between the two group (t=1.113, Z=-1.623，-1.468，-0.321， P>0.05). The duration of postoperative hospital stay in the LARP-PPC group and the LARP group were 16 days(range, 11-21 days) and 19 days (14-24 days), respectively, with a significant difference between the two groups (Z=-5.888, P<0.05)］. In the LARP-PPC group, time of PPC was (13±3)minutes. (2) Postoperative pathological examination: the length of specimen, the number of lymph node dissection, tumor diameter, cases with high, middle, and lowdifferentiated tumor in the LARP-PPC group was (18±4)cm, 16±5, (3.7±1.4)cm, 10, 34, 16 in the LARP-PPC group, and (18±4)cm, 16±5, (3.9±1.5) cm, 13, 41, 18 in the LARP group, showing no significant difference between the two groups (t=0.779, 0.390, 0.703, Z=-0.267, P>0.05). (3) Postoperative complications: cases with perineal wound infection, delayed perineal wound healing, intestinal obstruction, and perineal hernia were 2, 1, 1, 0 in the LARP-PPC group, and 12, 10, 8, 6 in the LARP group, showing significant differences between the two groups (x2=6.137, 6.400, P<0.05). There were 2 and 4 patients with urinary tract infection in the LARP-PPC group and the LARP group, respectively, showing no significant difference between the two groups (P>0.05).
    Conclusion:LARP-PPC is safe and feasible for the treatment of low rectal cancer, which can significantly reduce postoperative perinealrelated complications and consequently shorten postoperative hospital stay.

     

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