| Objective:Pass thruogh the clinical parameters and follow-up of patients undergoing partial internal sphincterectomy under laparoscopic total abdominal approach in our hospital in recent years,compared with laparoscopic ultra-low anterior resection and anal sphincter preservation,to explore the clinical effect and feasibility of partial internal sphincter resection.Methods:This article is a retrospective study of 121 patients with low rectal cancer who underwent anus reservation in the third department of surgery from January 2015 to December 2019.60 cases in the observation group underwent laparoscopic full transabdominal approach and partial internal sphincter resection to preserve the anus.61 cases of the control team,who underwent laparoscopic-assisted ultra-low anterior resection of rectal cancer during the same period to preserve anus.The general clinical data of the two groups were collected,and the postoperative anal function recovery,postoperative recurrent and survival prognosis were followed up for data collation and data analysis.Results:1.Comparison of basic clinical data : A total of 121 patients the two groups,60 in the observed group and 61 in the compared group.There was no statistical difference in the common clinical parameters between the two groups(p> 0.05),except that the distance from the lower margin of the tumor to the anorectal line in the observed group was lower than that in the compared group(2.05±0.48 cm vs 3.69±0.42 cm,p < 0.05).2.Comparison of during operation and post-operative outcomes between the two teams:The two groups were successfully completed by laparoscopy without conversion to laparotomy or dead case.The operation time in the observation group was slightly longer compared with control(109.7±8.1 min vs 101.17.6min,p<0.05),and the difference was statistically significant.There was no significant difference in intraoperative blood loss,postoperative exhaust time,postoperative ambulation time,postoperative drainage tube removal time,postoperative hospital stay and other correlated indexes between the observation group and the control group(p>0.05),including distal margin length,lymph nodes dissection,postoperative pathological TNM stage and other tumor safety indicators(p>0.05).3.Comparison of clinical complications:Postoperative complications occurred in 8 cases(13.3%)of the observation group and 7 cases(11.5%)of the control group.There was no statistical significance in the major clinical complications between the two groups,such as anastomotic leak,stenosis,bleeding,dysuria,pelvic infection and so on(p >0.05).4.Recovery of anal function:Patients in the two groups were excluded from preventive stoma after operation,40 patients in the observation group and 43 patients in the control group.The number of defecation after operation and the Williams standard were used to evaluate the control defecation function of patients.From 1 to 3 months after surgery,the average number of defecation in the observation group was higher than that in the control group(4.03±0.8 times / d vs 3.58±0.5 times / d,p= 0.02),and the good rate of defecation control was lower than that in the control group(57.5 % vs 86.0 %,p= 0.004),with statistical significance.Three to six months later,there was no significant statistical difference in defecation frequency and good rate of defecation control between the two groups(p > 0.05).5.Survival prognosis:The median follow-up time was 22 months for the observation group and 22 months for the control group.In the observation group,there were 2 patients with local recurrence(3.3 %)and 3 patients with distant metastasis(5 %);Local recurrence in control group was 3(4.9 %),distant metastasis was 3(4.9 %).In the study group,2 cases(3.3 %)had local recurrence and 3 cases(5 %)had distant metastasis,while in the control group,3 cases(4.9 %)and 3 cases(4.9 %)respectively.Observation group of disease-free survival and overall survival rates were 91.7% and 98.3%,while the control group was 90.2% and 96.7%;survival outcome differences did not see the obvious statistical significance(p > 0.05).Conclusion:Low rectal cancer patients(from dentate line > 1.0cm)by improving preoperative examination,evaluation,accurate clinical staging,laparoscopic total abdominal approach partial internal sphincter resection is safe and feasible,worthy of promotion. |
