CAJ | 학술논문

目的：探讨腹腔镜全直肠系膜（TME）联合经肛门内括约肌切除（ISR）治疗低位直肠癌的疗效，评估手术的安全性。方法回顾性分析2009年1月至2012年12月采用腹腔镜TME联合ISR术治疗的42例低位直肠肿瘤患者（腹腔镜组），同时选取2006年1月至2012年12月开腹行TME联合ISR术治疗的44例低位直肠肿瘤患者（开腹组）。比较分析两组患者的一般资料、手术情况、临床病理特点、术后并发症和术后生活质量。结果两组患者的一般情况和术后临床病理特点相近。腹腔镜组患者均顺利完成手术，总体手术时间（min）明显小于开腹组（181.2±65.4 vs 216.6±82.9，t=2.192，P=0.031），出血量（ml）亦明显小于开腹组（83.2±37.5 vs 117.4±33.0，t=4.495，P<0.01）。4例低位直肠癌患者发生吻合口瘘，经保守治疗治愈，并发症发生率与开腹组相比差异无统计学意义。两组患者肛门功能自我评价以及KIRWAN分级差异均无统计学意义。结论对于术前评估早中期低位甚至超低位直肠癌，特别是肿瘤没有侵犯肛门内括约肌的患者，采用腹腔镜TME联合ISR术是安全可行的，提高了保肛成功率，保留患者术后肛门括约肌功能，改善生活质量。
목적：탐토복강경전직장계막（TME）연합경항문내괄약기절제（ISR）치료저위직장암적료효，평고수술적안전성。방법회고성분석2009년1월지2012년12월채용복강경TME연합ISR술치료적42례저위직장종류환자（복강경조），동시선취2006년1월지2012년12월개복행TME연합ISR술치료적44례저위직장종류환자（개복조）。비교분석량조환자적일반자료、수술정황、림상병리특점、술후병발증화술후생활질량。결과량조환자적일반정황화술후림상병리특점상근。복강경조환자균순리완성수술，총체수술시간（min）명현소우개복조（181.2±65.4 vs 216.6±82.9，t=2.192，P=0.031），출혈량（ml）역명현소우개복조（83.2±37.5 vs 117.4±33.0，t=4.495，P<0.01）。4례저위직장암환자발생문합구루，경보수치료치유，병발증발생솔여개복조상비차이무통계학의의。량조환자항문공능자아평개이급KIRWAN분급차이균무통계학의의。결론대우술전평고조중기저위심지초저위직장암，특별시종류몰유침범항문내괄약기적환자，채용복강경TME연합ISR술시안전가행적，제고료보항성공솔，보류환자술후항문괄약기공능，개선생활질량。
Objective To investigate the effect and safety of laparoscopic total mesorectal excision (TME) combined with intersphincteric resection (ISR) for low rectal cancer. Methods Forty-two patients of low rectal cancer were performed laparoscopy-assisted TME combined with ISR (laparoscopy-assisted group) from January 2009 to December 2012 and other forty-four cases underwent open surgery (open group) from January 2006 to December 2012. Demographic and perioperative data, including complications and short-term functional outcome were compared between the two groups. Results Patients of laparoscopy-assisted group successfully underwent operation, and none were transferred to open procedure or laparoscopic Mile's surgery. There were no distribution differences in demographic and perioperative data between the two groups. The average operation time was significantly shorter in laparoscopy-assisted group than in open group (181.2±65.4 min vs 216.6±82.9 min, t=2.192, P=0.031). The laparoscopy-assisted group had less blood loss compared with the open cases (83.2±37.5 ml vs 117.4±33.0 ml, t=4.495, P<0.01). The rates of overall complications, infection complications and non-infection complications were similar between the two groups. Anastomotic leakage occurred in 4 cases and they were cured by conservative therapy. The patients of both groups were satisfied with the postoperative anal sphincter function. Conculsions It is feasible for the appropriate patients with very low rectal cancer to undergo laparoscopic TME combined with ISR, especially for those in early stage, without cancer invasion to the external sphincter. The approach increases the possibility of anal preservation and improves the quality of life.