目的 比较改良Bacon术与一期结肠肛管吻合联合末端回肠造口治疗低位直肠癌的近、远期疗效。
方法 回顾性分析2015年1月至2023年1月郑州大学第一附属医院结直肠肛门外科收治的631例腹腔镜低位直肠癌手术病人的临床资料，按手术方式分为改良Bacon手术（改良Bacon组）和一期结肠肛管吻合联合末端回肠造口（一期吻合组）。采用倾向性评分匹配法按1∶1进行组间匹配。比较匹配后两组病人的一般资料、手术相关指标、并发症发生率和术后肛门功能。应用Kaplan-Meier曲线法绘制生存曲线，Log-rank检验进行生存分析。结果 631例病人中，342例配对成功，两组各171例。匹配后两组病人的一般资料比较，差异均无统计学意义（均P>0.05）。与一期吻合组相比，改良Bacon组病人两次手术时间均相对更短［第1次：（170.2±13.7）min vs. （191.9±17.4）min，t=-12.821，P<0.001；第2次：（45.3±5.0）min vs.（66.3±6.7）min，t=-32.693，P<0.001］，两次手术后疼痛评分均更低［第1次：3（2，3）分 vs. 5（4，5）分，Z=-11.663，P<0.001）；第2次：2（2，3）分 vs. 5（4，5）分，Z=-14.334，P<0.001）］，第2次手术出血量更少［10（10，15）mL vs. 15（15，20）mL，Z=-11.495，P<0.001］，总手术费用更少［（91 845±11 109）元 vs.（110 838±8744）元，t=-17.568，P<0.001］，第2次术后并发症Clavien-Dindo分级更低（Z=-2.193，P=0.028）；而在第1次手术出血量、第1次术后并发症发生率、术后1年肛门功能方面差异无统计学意义。两组病人3年无病生存率和总生存率差异无统计学意义（χ2=0.285、0.208，P=0.593、0.648）。结论 改良Bacon术是一种安全、微创、经济、有效的手术方式，适用于有保肛需求且不愿造口的低位直肠癌病人。
Abstract
To compare the short‑term and long‑term outcomes of modified Bacon surgery (MBS) and immediate coloanal anastomosis (ICA) with protective loop ileostomy in the treatment of low rectal cancer. Methods The clinical data of 631 low rectal cancer patients undergoing laparoscopic proctectomy at the Department of Colorectal Surgery, the First Affiliated Hospital of Zhengzhou University between January 2015 and January 2023 was analyzed retrospectively and divided into MBS group and ICA group. Propensity score matching (PSM) was performed in a 1:1 ratio to balance baseline characteristics between the two groups. Post-matching comparisons were made with respect to the general information, operative-related indicators, postoperative complication rates and anal function. Kaplan-Meier survival curves were generated, and survival analysis was performed using the Log-rank test. Results 342 of 631 patients were successfully matched, including 171 cases in each group, respectively. After matching, no significant differences were observed in baseline characteristics between the two groups (all P>0.05). Compared with the ICA group, the MBS group exhibited shorter first operation time (170.2±13.7 min vs. 191.9±17.4 min, t=-12.821, P<0.001) and second operation time (45.3±5.0 min vs. 66.3±6.7 min, t=-32.693, P<0.001), lower postoperative pain scores ［3 (2, 3) vs. 5 (4, 5) after the first surgery (Z=-11.663, P<0.001) and 2 (2, 3) vs. 5 (4, 5) after the second-stage surgery (Z=-14.334, P<0.001)］, lower intraoperative blood loss during the second surgery ［10 (10, 15) mL vs. 15 (15, 20) mL, Z=-11.495, P<0.001］, lower total surgical costs ［(91 845±11 109) CNY vs. (110 838±8744) CNY, t=-17.568, P<0.001］, and a lower Clavien-Dindo grades of postoperative complications after the second surgery (Z=-2.193, P=0.028). However, no significant differences were found between the two groups in terms of blood loss during the first surgery, the incidence of postoperative complications after the first surgery, or anal function at 1 year postoperatively. Moreover, no significant differences were observed in the 3-year disease-free survival or overall survival between the two groups (χ²=0.285 and 0.208, P=0.593 and 0.648, respectively). Conclusion Modified Bacon surgery is a safe, minimally invasive, economical, and effective surgical procedure, which provides a stoma-sparing alternative for patients expecting anal preservation with low rectal cancer.
关键词
改良Bacon术 /
低位直肠癌 /
腹腔镜 /
保护性回肠造口
Key words
modified Bacon surgery /
low rectal cancer /
laparoscopy /
protective loop ileostomy
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