改良Bacon术联合腹腔镜下括约肌间切除术在低位直肠癌保肛术中的应用效果和安全性

摘要 目的：探讨改良Bacon术联合腹腔镜下括约肌间切除术（Lap-ISR）在低位直肠癌保肛术中的应用效果和安全性。方法：选择2019年10月到2021年5月在本院诊治的低位直肠癌患者78例作为研究对象，根据1:1随机分配原则把患者分为改良组与对照组各39例，对照组给予腹腔镜下括约肌间切除术，改良组在对照组治疗的基础上给予改良Bacon术，记录两组的治疗效果与安全性状况。结果：改良组的手术时间与对照组对比无差异（P>0.05），改良组的术中出血量、术后正常饮食时间、术后肛门排气时间、术后住院时间少于对照组（P<0.05）。改良组术后14 d的吻合口瘘、盆腔脓肿、切口出血、尿潴留、静脉血栓等并发症发生率为5.1 %，低于对照组的30.8 %（P<0.05）。改良组术后3个月的肛门功能Williams分级好于对照组（P<0.05）。改良组术后1个月与3个月的肛门排便Wexner评分少于对照组（P<0.05）。改良组术后3个月的躯体功能、情绪机能、社会职能、症状体征等生活质量评分高于对照组（P<0.05）。结论：改良Bacon术联合腹腔镜下括约肌间切除术在低位直肠癌保肛术中的应用能促进恢复患者的肛门功能，能减少对患者的创伤，促进患者康复，降低术后并发症，从而持续提高患者的生活质量。

Application Effect and Safety of Modified Bacon Operation Combined with Laparoscopic Intersphinc Resection in Sphincter-preserving Surgery for Low Rectal Cancer

ABSTRACT Objective: To investigate the application effect and safety of modified Bacon operation combined with laparoscopic intersphincteric resection (Lap-ISR) in sphincter-preserving surgery for low rectal cancer. Methods: From October 2019 to May 2021, 78 cases of patients with low rectal cancer who were diagnosed and treated in our hospital were selected as the research subjects. All the cases were divided into the modified group and the control group with 39 cases in each groups accorded to the 1:1 random allocation principle. The control group were given laparoscopic intersphincterectomy, and the modified group were given modified Bacon technique combined with laparoscopic intersphincterectomy, and the therapeutic effect and safety status of the two groups were recorded. Results: There were no difference in the operation time compared between the modified group and the control group(P>0.05). The amount of intraoperative blood loss, postoperative normal eating time, postoperative anal exhaust time, and postoperative hospital stay in the modified group were less than those in the control group. group (P<0.05). The incidence rates of complications such as anastomotic leakage, pelvic abscess, incision bleeding, urinary retention, and venous thrombosis in the modified group at 14 days after operation were 5.1 %, which were lower than 30.8 % in the control group (P<0.05). The Williams grade of anal function in the modified group at 3 months after operation were better than that in the control group(P<0.05). The Wexner score of anal defecation in the modified group at 1 month and 3 months after operation were lower than that in the control group(P<0.05). The physical function, emotional function, social function, symptoms and signs and other quality of life scores of the improved group were higher than those of the control group at 3 months after operation (P<0.05). Conclusion: The application of modified Bacon technique combined with laparoscopic intersphincterectomy in sphincter-preserving surgery for low rectal cancer can promote the recovery of patients'' anal function, reduce trauma to patients, promote patient recovery, and reduce postoperative complications. In order to continuously improve the quality of life of patients.