摘要目的 探讨经肛门扩大全层切除早期低位直肠癌的优势及预后.方法 回顾性分析2003年1月至2010年12月163例实施早期低位直肠癌手术患者临床资料,按照不同手术方式分为经肛门局部扩大全层切除组(A组)(78例)、传统开腹手术组(B组)(85例),比较两组手术情况及生存情况.结果 A组在手术时间[(43.17±12.31)min比(216.41±60.12) min,t=12.924,P=0.011]、术中中位出血量(30 ml比110 ml,Z=-2.522,P=0.012)、术后肠道功能恢复时间[(1.61±0.76)d比(3.72±1.46)d,t=2.681,P=0.037]、术后住院时间[(5.39±1.21)d比(22.79±8.31)d,t=6.964,P=0.023]、并发症发生率[3.85％(3/78)比24.71％(21/85),x 2=14.096,P＜ 0.001]方面均优于B组.A组1、3、5年累积生存率分别为100.0％、93.5％、89.5％,B组分别为98.8％、95.2％、90.3％,A组、B组平均生存时间分别为57.08个月及57.49个月,两组比较差异无统计学意义(P＞0.05).结论 经肛门局部扩大全层切除术治疗早期低位直肠癌可获得与传统开腹手术相近的远期生存率,并在手术时间、出血量、术后恢复速度、并发症等方面有较大优势.

abstractsObjective To investigate the advantages and prognosis of extended full-thickness transanal local excision in treating early stage low rectal cancer.Methods Clinical gastrointestinal surgery data of transanal local excision surgeries of 163 patients from January 2003 to December 2010 was reviewed.According to the different operation modes,the patients were divided into group A (transanal local expanded full-thickness resection group,78 cases),group B (traditional open operation group,85 cases),to observe the operation status and survival time.Results The operative time [(43.17±12.31) min vs (216.41±60.12) min,t =12.924,P =0.011],the volume of bleeding (30 ml vs 110 ml,Z =-2.522,P =0.012),the postoperative intestinal function recovery time [(1.61±0.76) d vs (3.72±1.46) d,t =2.681,P =0.037),the postoperative hospital stay [(5.39±1.21) d vs (22.79±8.31) d,t =6.964,P =0.023),the rate of complication [3.85 ％ (3/78)vs 24.71％ (21/85),x2 =14.096,P ＜ 0.001] of group A and group B showed statistical significance (P ＜ 0.05),1 year,3 years,5 years survival rate of group A and group B were 100.0 ％,93.5 ％,89.5 ％ and 98.8 ％,95.2 ％,90.3 ％ respectively,the average survival time were respectively 57.08 months and 57.49 months,with no statistical difference (P ＞ 0.05).Conclusions The extended full-thickness transanal local excision in treating early stage low rectal cancer can achieve the effect of laparotomy.Compared with laparotomy,it has more advantages such as shorter operative time,less bleeding,less invasive,faster postoperative recovery,and fewer occurrences of complications.