探讨选择混合入路与传统中央入路在腹腔镜直肠癌手术的临床疗效。

采用回顾性分析自2020年1月至2020年6月因患直肠癌在河北医科大学第四医院外二科接受腹腔镜直肠根治骶前吻合术的64位患者的临床资料，依照不同手术入路分为2组。32例直肠癌患者术中采取混合入路。32例直肠癌患者术中采取传统中央入路组。观察指标：手术情况：手术时间、出血量、离断IMA后扩展左侧Toldt’s筋膜时间、术后患者排气时间、术后出院时间；手术并发症情况：吻合口瘘、肠梗阻、尿潴留、吻合口出血；随访情况：术后1年患者的生存情况、肿瘤局部复发情况、肿瘤远处转移情况。正态分布的计量资料以

2组患者共62例患者均顺利完成腹腔镜直肠癌根治术，围手术期无意外死亡，手术期间均未中转开腹。混合入路组和传统中间入路组手术时间分别为（109.75±5.76）min和（108.16±2.65）min，术中出血量分别为（90.62±3.97）ml和（92.12±1.96）ml，扩展左侧Toldt’s筋膜时间为（6.50±1.50）min和（15.63±1.68）min，术后患者排气时间分别为（2.28±0.96）d和（2.31±0.47）d，患者术后出院时间为（6.91±1.09）d和（6.89±1.84）d。2组患者手术时间、术中出血量、术后排气时间、术后出院时间比较，差异均无统计学意义（P＞0.05）；其中扩展左侧Toldt’s筋膜时间比较，差异有统计学意义（P＜0.05）；术后并发症情况：混合入路组术后发生总的并发症例数4例，对照组7例，2组比较差异均无统计学意义（χ²＝0.98，P=0.32）。随访情况：2组64例患者均接受了术后随访。随访时间为4~10个月，中位随访时间为7个月。随访期间患者均未出现复发及远处转移，无肿瘤相关性死亡。

混合入路在腹腔镜直肠癌根治术应用与传统中央入路比较同样安全有效，其更能缩短分离左侧Toldt’s筋膜的时间。

To investigate the clinical efficacy of hybrid approach versus traditional central approach in laparoscopic radical resection of rectal cancer.

A retrospective analysis was performed on the clinical data of 64 patients who underwent laparoscopic radical rectal resection and anterior sacral anastomosis for rectal cancer at our hospital from January 2020 to June 2020, and they were divided into two groups according to the surgical approach used (32 patients each were operated via the hybrid approach, and the traditional central approach. Outcome measures evaluated included surgical parameters (operation time, blood loss, time of separating the left Toldt's fascia after inferior mesenteric artery separation, time to postoperative exhaust, and time to postoperative discharge time), surgical complications (anastomotic fistula, intestinal obstruction, urinary retention, and anastomotic bleeding), and follow-up indicators (survival, local recurrence, and distant metastasis of the tumor at 1 year after surgery). Measurement data with a normal distribution are expressed as the mean±standard deviation, and the t-test was used for comparison between groups. Counting data were compared by the chi-square test.

A total of 62 patients in the two groups successfully completed laparoscopic radical resection of rectal cancer, and there was no accidental death occurred during the perioperative period and no conversion to open surgery. There was no significant difference between the hybrid approach group and the traditional central approach group in operation time [(109.75±5.76) min vs (108.16±2.65) min, P＞0.05], intraoperative blood loss [(90.62±3.97) ml vs (92.12±1.96) ml, P＞0.05], time to postoperative exhaust [(2.28±0.96) d vs (2.31±0.47) d, P＞0.05], and time to postoperative discharge [(6.91±1.09) d vs (6.89±1.84) d, P＞0.05]. However, the time of separating the left Toldt's fascia was significantly shorter in the hybrid approach group than in the traditional central approach group [(6.50±1.50) min vs (15.63±1.68) min, P＜0.05]. There were four cases of postoperative complications in the hybrid approach group and seven cases in the control group, and there was no significant difference between the two groups (χ²＝0.98, P=0.32). All the 64 patients in the two groups received postoperative follow-up. The time of follow-up ranged from 4~10 months, with a median of 7 months. No recurrence, distant metastasis, or tumor-related death occurred during the follow-up period.

The hybrid approach is as safe and effective as the traditional central approach in laparoscopic radical resection of rectal cancer, and it can shorten the time of separating the left Toldt's fascia.