作者：张敏, 黄炯强

单位：广州医科大学附属第一医院 胃肠外科，广东 广州 510120

Authors: Zhang Min, Huang Jiongqiang

Unit: Department of Gastrointestinal Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong, China

摘要：

目的 比较经肛门全直肠系膜切除术(transanal total mesorectal excision, TaTME)与腹腔镜全直肠系膜切除术(laparoscopic total mesorectal excision, LaTME)在中低位直肠癌治疗中的短、长期疗效。方法 回顾性分析2010年5月到2016年1月28例施行TaTME患者的临床病理资料(TaTME组)。随机抽取同一手术团队同一时期28例施行LaTME患者,其中1例LaTME患者因失访被排除,最后纳入27例LaTME患者作为对照组(LaTME组)。比较两组患者围术期的各项指标以及长期疗效。结果 两组患者的性别、年龄、体质量指数(body mass index, BMI)、肿瘤直径、肿瘤下缘距齿状线距离、ASA分级、术前T分期、N分期等术前临床资料无明显差异。(P>0.05)。两组患者的手术时间、术中出血量、术后住院时间、术后并发症例数、淋巴结获取数目比较,差异均无统计学意义(P>0.05)。相对于LaTME组,TaTME组术中中转开腹率明显降低(0比18.5%),术后首次肛门排气时间明显缩短[2(1,3)d比3(2,4)d](P<0.05)。在3年的随访中,两组的累积局部复发率、总体生存率和无病生存率比较,差异无统计学意义(P>0.05)。结论 TaTME在中低位直肠癌的治疗中是可行和安全的。

关键词：直肠癌; 经肛门全直肠系膜切除术; 腹腔镜全直肠系膜切除术

Abstract：

Objective To compare the short-and long-term efficacies of transanal total mesorectal excision (TaTME)and laparoscopic total mesorectal excision(LaTME)for the treatment of mid and low rectal cancer. Methods The clinicopathological data of 28 patients undergoing TaTME performed from May 2010 to January 2016 were retrospectively analyzed (TaTME group). 28 LaTME patients who were performed by the same surgical team during the same period were randomly selected, and one of the LaTME patients was excluded due to incomplete follow-up, finally, 27 patients undergoing LaTME were included as control group (LaTME group). Several indicators of perioperative period and long-term efficacies were compared between the two groups. Results There was no significant difference in preoperative data between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay after operation, postoperative complications and harvested lymph nodes were no statistically significant differences between the two groups (P>0.05). Compared with the LaTME group, the intraoperative conversion rate to open procedures in TaTME group was significantly reduced (0 vs 18.5%), and the first anal exhaust time after surgery was significantly shorter [2(1,3)d vs 3(2,4)d] (P<0.05). In the 3-year follow-up, there was no significant differences between the two groups in the cumulative local recurrence rate, overall survival and disease-free survival (P>0.05). Conclusion TaTME is feasible and safe in the treatment of mid and low rectal cancer.

Key Words: Rectal cancer; Transanal total mesorectal excision; Laparoscopic total mesorectal excision