Clinical Analysis Of Laparoscopic Assisted Transanal Total Mesorectal Excision Surgery In Middle And Low Rectal Carcinoma In 7 Cases

Objective: To study the clinical efficacy,recent follow-up results,perioperative complications and the effect of the operation on anal function in transanal total mesorectal excision.Combined with the clinical data of patients undergoing laparoscopic radical resection for rectal cancer in our department.To study the differences between the two in terms of health economics significance,effectiveness,safety ect.METHODS: Collect the clinical data of who was diagnosed by the Department of General Surgery,First Affiliated Hospital of Dalian Medical University during the January 2016 to October 2018 with the middle and lower rectal cancer.And 7 patients underwent laparoscopically assisted TaTME surgery.And 21 patients who went with traditional laparoscopic surgery.Both group was perform with same group of surgeons.Compare the two group in(1)surgery performs: include operation time,intraoper ative blood loss,Prophylactic fistula,and surgery fee;(2)Perioperative condition:time after surgery to start eating non-flat food,postoperative exhaust time,post operative retention catheterization time,postoperative indwelling gastric tube time,complications within 30 days after surgery,and postoperative hospitalization.(3)Postoperative pathological examination: the length of postoperative pathological sp ecimens,the number of lymph nodes obtained,the number of positive lymph no des,the distance from the distal margin of the tumor to the distal margin,and t he number of positive margins around the margin.(4)Follow-up methods: follow-up by outpatient and telephone surveys.To understand the local recurrence,distant metastasis and recovery of anal function in patients.The statistical values we re calculated by SPSS software for analysis and research.Result:General information: A total of 28 patients,including 18 males and 10 females,aged 29-82.Tumor differentiation: Well-differentiated 4 case Moderately differentiated 24 case.TNM subsets I stage 8 case,II stage 13 case,IIIstage 7 case.There was no significant difference in general data of two group.Surgical parameters: There were no major bleeding complications in the whole group,no perioperative deaths,and 1 case of rectal vaginal fistula occurred.There was no statistically significant difference in the complications between the two groups during and after surgery.Operation time laparoscopic surgery time 182.38±52.81 min,TaTME group time 251.43±41.40min(P<0.05).The difference was statistically significant.Intraoperative bleeding volume:The Lp group 12.05±7.78 ml,TaTME group 42.86±40.30 ml,The difference was statistically significant.(P<0.05)The distal distance of the tumor from the cutting edge is 1.06±0.63cm、2.14±1.90 cm.There was no statistically significant difference in two grup.The average diameter of the tumor is 2.13±0.88 cm and 3.50±1.20 cm.Number of lymph node acquisition is 7.86±2.12 and 8.33±3.57(P>0.05)There was no statistically significant difference in two grup.Operation cost in two group is 28230.43±9812.75 yuan and 44612.81±6858.61 yuan The difference was statistically significant(P<0.05)Postoperative follow-up results: TaTME group Wexner score is three months 15.17±1.72,six months 9.33±2.94,twelve month 2.17±1.60.The lap group Wexner score is three months 17.10±1.22,six months 10.89±3.07,twelve month 4.18±2.36.In the three months Wexner score of two group was statistically significant.Although the anus function of the two groups was slightly lower than that before surgery Overall the TaTME group score is lower,anal function recovery time is earlier than the lap group.Conclusion:This study is based on a total of 28 patient’s general data,include surgical efficacy,recent follow-up results,perioperative complications,anal function,and health economics were compared and analyzed,and the following conclusions were drawn.In the group of TaTME with ensure the surgical effect,pathological results,and radical tumors,the perioperative complications were not increased,and the operation cost was lower,and the postoperative anal function recovered more quickly.In 1 year tumor-free survival rate was not statistically significant between the two groups.And at the anus function preservation has potential advantages.In terms of health economics significance,effectiveness,safety.In the patient’s postoperative quality of life,which has certain health economic significance.The sample size of this study was small and the follow-up time was short.The data of the two groups were retrospective non-randomized controlled studies.Clinical efficacy remains to be confirmed by long-term follow-up of large samples.