Application Of Laparoscopic Intersphincteric Resection In Anus Preserving Operation For Ultra-low Rectal Cancer

Purpose To discuss the feasibility of laparoscopic Intersphincteric resection for patients with T1 and T2 ultra-low rectal cancer.Methods 22 cases of laparoscopic ISR,21 cases of ISR and 20 cases of laparoscopic Dixon in our hospital during 2010-2015 were analyzed retrospectively,The observation included intraoperative bleeding,hospitalization,the number of patients that anal pain and anastomotic fistula happend,postoperative Wexner scores,anal resting press(ARP),rectal maximum squeeze pressure(MSP),rectal maximum tolerable volume(MTV)were compared between patients undergoing laparoscopic ISR and open ISR;and observation included Wexner scores ARP,MSP and MTV were compared between patients undergoing laparoscopic ISR and laparoscopic Dixon.It was used to demonstrate the safety and feasibility of Laparoscopic Intersphincteric resection in anus preserving operation for ultra-low rectal cancer.Results The operation time of Laparoscopic ISR group(344±47min)was longer than the time of open ISR group(221±19 min),and the intraoperative blood loss(124 ±55ml)was less than that in the open group(210 ±95ml ml)and the hospitalization time(11.0±2.6 Day)was lower than that in the open group(13.5 ±3.7days)(P <0.05).There was no significant difference in the probability of anastomotic fistula,Laparoscopic ISR group showed less anal pain after surgery than the open ISR group(P < 0.05).There were no differences in Wexner score,ARP,MSP and MTV between two groups(all p >0.0.5).3 months after opration,significant differences between Laparoscopic ISR group and Laparoscopic Dixon groupwere as follows:Wexner score [(4.3±1.8)vs(2.0±1.2)]ARP[(29.8±4.8)mm Hg vs(41.6±6.7)mm Hg] ?MSP[(105.6±15.9)mm Hgvs(119.1±19.0)mm Hg],MTV[(102.4±15.0)mm Hgvs(117.7±19.3)mm Hg].12 months after opration,There were no differences in Wexner score,ARP,MSP and MTV between two groups.Conclusion 1.Ccmpared with less open ISR,Laparoscopic ISR surgery has less bleeding and shorter hospital stay,Its short-term effect is better,There was not significantly difference in Anal function between 2 groups.2.The short-term effect of postoperative anal function after laparoscopic ISR was worse than that of laparoscopic Dixon,the function returned to the same level after 1 year,and anal function after laparoscopic ISR was worse than preoperation.