Observation on the Efficacy of Hand-Assisted Laparoscopic Surgery Com-bined with Total Laparoscopic Surgery for the Treatment of Low-Lying Locally Advanced Rectal Cancer
ZHANG Hanshuo
LIU Shaojie
ZHONG Qiguang
ZHU Weicong
Abstract：Objective To explore the efficacy of hand-assisted laparoscopic surgery(HALS)combined with total laparoscopic surgery(LAP)in the treatment of low-lying locally advanced rectal cancer,so as to prevent delayed treatment and reduce postoperative complications.Methods A total of 198 patients with low-lying locally advanced rectal cancer admit-ted from December 2022 to January 2024 were selected and randomly divided into three groups:the HALS group,the LAP group,and the combination group,with 66 patients in each group.The LAP group,the HALS group and the combination group underwent LAP,HALS,and LAP combined with HALS,respectively.The intraoperative blood loss,number of lymph nodes dissected,duration of operation,postoperative anal exhaust time,time to ambulation,and length of hospital stay were compared among the three groups.C reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and serum amyloid A(SAA)levels were compared before surgery,and at 1,3,and 7 d after surgery.Rectal anal inhibitory reflex threshold(AIRT),maximum tolerated volume(MTV),maximum anal squeeze pressure(MSP),anal resting pressure(ARP),rectal resting pressure(RRP),and postoperative complication rate were also compared before surgery and at 3 months after surgery.Results The intraoperative blood loss,duration of operation,postoperative anal exhaust time,time to ambulation,and length of hospital stay in the combination group were less or shorter than those in the HALS group and LAP group,with the HALS group being less or shorter than the LAP group(P＜0.05).Serum levels of CRP,TNF-α,IL-6,and SAA at 1,3,and 7 d after surgery were lower in the combination group than in the HALS group and LAP group,with the HALS group being lower than the LAP group(P＜0.05).At 3 months after surgery,MSP,ARP,and MTV were higher in the combination group than in the HALS group and LAP group,with the HALS group being higher than the LAP group.Mean-while,RRP and AIRT were lower in the combination group than in the HALS group and LAP group,with the HALS group be-ing lower than the LAP group(P＜0.05).The total incidence of postoperative complications in the combination group was lower than that in the LAP group(P＜0.05).Conclusion HALS combined with LAP for the treatment of low-lying locally advanced rectal cancer has minimal trauma and rapid postoperative recovery,and can effectively improve anorectal function,reduce postoperative complications,and avoid delayed treatment.
Keywords：Low-lying rectal tumorLocally advanced stageHand-Assisted laparoscopic surgeryTotal laparoscopic surgeryDuration of operationC reactive proteinAnal resting pressurePostoperative complications
Publication Date：2024-12-15
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 48-53 )