| Objective: To compare and analyze the clinical effects of laparoscopic transabdominal partial internal sphincterectomy(pISR)and laparoscopic low rectal anterior resection in the treatment of low rectal cancer,including postoperative recovery,complications,recent radical tumor resection results,and anal function,Further elaborated that laparoscopic transabdominal pISR surgery in the treatment of low rectal cancer has the same short-term curative effect,surgical complications,and anal function.Compared with laparoscopic low surgery,it is a safe and feasible anus preservation.The surgical procedure can be applied in clinical practice.Methods: A retrospective analysis of patients with low rectal cancer diagnosed from March 2017 to December 2018.Random numbers were used to randomly select 50 patients undergoing laparoscopic partial internal sphincterectomy(pISR)via abdominal approach as the pISR test group,and random numbers were used to randomize them 50 cases of laparoscopic low anterior rectal resection were selected as the LAR control group.Case inclusion criteria: 1.Colonoscopy and pathological diagnosis of rectal cancer,the pathological type is high/moderately differentiated cancer;2.Anal examination judges that the lower edge of the tumor is ≤5cm from the anal edge but ≥2cm from the dentate line,which is completed After separation of the terminal mesangium,laparoscopy and inferior transanal examination confirmed that the lower edge of the tumor is less than 1-2 cm from the upper edge of the levator ani hiatus to undergo pISR;3.The preoperative anal function assessment is good,and the anal sphincter tension is normal.4.High-resolution MRI rectal staging is within C-T2,without infringement on the joint muscles and external sphincter.Exclusion criteria:(1)Patients with severe insufficiency of important organs,such as heart,liver,liver,and kidney diseases;(2)Preoperative intestinal obstruction,intestinal perforation,severe gastrointestinal bleeding;(3)Old age or anus Relaxation or incontinence;(4)Poorly differentiated or undifferentiated cancer,with a long range of reverse mucosal infiltration,and safe margins cannot be guaranteed;(5)Imaging stage C-T3 or higher(those who have infiltrated or exceeded the combined longitudinal muscle).50 patients were included in the pISR group,including 24 males(48%)and 26 females(52%);ages were 31 to 69 years old,with an average of(54.90±11.07)years old;BMI23.01±2.36(Kg.m-2);The depth of tumor invasion(high-resolution MRI)C-T1 11cases(22.0%),C-T2 39 cases(78%);postoperative pathological TNM staging in29 cases(58%)in stage I,8 cases in stage II(16 %),13 cases(26%)in stage III;the distance between the lower level of the tumor and the anal margin was3.83±0.80 cm.The LAR group included 50 patients,including 26 males(52%)and24 females(48%);ages were 23 to 68 years old,with an average of(56.64±10.45)years old;BMI 22.12±2.95(Kg.m-2);The depth of tumor invasion(high resolution MRI)C-T1 13 cases(26.0%),C-T2 37 cases(74%);postoperative pathological TNM stage I stage 25 cases(50%),II stage 15 cases(30 %),10 cases(20%)in stage III;the distance between the lower level of the tumor and the anal margin was4.81±0.84 cm.There was no difference in gender,age,BMI,depth of invasion,and staging between the two groups,and the difference was not statistically significant(P>0.05),and the two groups were comparable.Compared with the LAR group,the tumor location in the pISR group was lower,and the distance from the inferior to the anal margin was about 1.0 cm lower than that in the LAR group.The difference was statistically significant(P<0.05),which was in line with the clinic.Perioperative indicators(operating time,intraoperative blood loss),recent radical tumor treatment effects(total number of lymph nodes and positive lymph nodes,CRM,inferior resection margin),and recent postoperative complications(postoperative recovery time,anastomotic leakage,Anastomotic bleeding,abdominal infection,intestinal obstruction,urinary retention,and other complications)and anal function scores(3 months,6 months,and 1 year after stoma reduction)were compared and analyzed.Results:1.The operation time of the pISR group was longer than that of the LAR group(155.10±22.26 min vs 146.30±17.09min),the difference was statistically significant(P<0.05).Intraoperative blood loss between the two groups(41.60±21.13 ml vs36.30±13.13ml),there was no difference in postoperative blood loss,and the difference was not statistically significant(P>0.05).The postoperative recovery time in the pISR group was(6.72±0.93)days,and the postoperative recovery time in the LAR group was(6.58±0.88)days,the difference was not statistically significant(P>0.05).2.In terms of the recent curative effect of tumors,the total number of lymph nodes in the pISR group(17.04±6.40),the number of positive lymph nodes(1.38±2.42),CRM negative(50,100.0%),and lower resection margin negative(50,100%);and The total number of lymph nodes in the LAR group(20.02±8.76),the number of positive lymph nodes(1.26±2.26),CRM negative(50,100.0%),and inferior resection margin negative(50,100%);there was no difference between the two,and the difference was not statistically significant Significance(P>0.05).3.In terms of postoperative recovery and complications,3(6.0%)cases of anastomotic leakage occurred in the pISR group,2(4.0%)cases of anastomotic bleeding,1(2.0%)cases of abdominal infection,4(8.0%)cases Intestinal obstruction,2(4.0%)cases of urinary retention,and 3(6.0%)cases of other complications.In the LAR group,4(8.0%)cases of anastomotic leakage occurred,3(6.0%)cases of anastomotic bleeding,2(4.0%)cases of abdominal infection,5(10.0%)cases of intestinal obstruction,and 2(4.0%)cases of urine Retention and 4(8.0%)cases of other complications.Compared with the LAR group,the pISR group had no difference in anastomotic leakage,anastomotic bleeding,abdominal infection,intestinal obstruction,urinary retention and other complications,and the differences were not statistically significant(P>0.05).The total complication rate of the pISR group(15,30%)was similar to that of the LAR group(20,40%),and the difference was not statistically significant(P>0.05).4.Patients were followed up for more than 2 year,and 3 months after the stoma,34(68.0)patients with severe anal function in pISR group,16(36.0)patients with mild anal function in pISR group,and patients with severe anal function in LAR group There were 26(52.0)cases and 24(48.0)cases with mild anal function.The number of patients with severe anal dysfunction in the pISR group was significantly higher than that in the ultra-low group.The difference was statistically significant(P<0.05).There was no difference between people with mild anal dysfunction,and the difference was not statistically significant(P>0.05);6 months after surgery,it was found that the number of people with severe anal dysfunction in the two groups was significantly reduced,but there was no difference,and the difference was not statistically significant.Significance(P>0.05).Compared with the LAR group,there was no difference in patients with abnormal anal function one year after the operation in the pISR group,and the difference was not statistically significant(P>0.05).Conclusion:Laparoscopic transabdominal partial internal sphincterectomy(pISR)is a safe and effective anus-preserving operation for the treatment of low rectal cancer.Compared with laparoscopic low rectal anterior resection,pISR can treat lower rectal cancer.Carcinoma,such as a tumor 1.0 cm on the dentate line,undergo anal preservation surgery.Although pISR operation time is relatively longer than10-15 minutes,and the anal function at 3 months after operation will be worse than that of the LAR group,but it is not different from the LAR group in terms of recent radical tumor resection and postoperative complications,and through anal exercise Anal function can gradually recover 6 months after surgery,and most patients will get satisfactory anal function within six months to one year after surgery.Laparoscopic transabdominal pISR surgery is a safe and effective anus-preserving surgery.It can be used clinically by strictly grasping the surgical indications. |
PDF Full Text Request