小切口辅助下腹腔镜直肠癌根治术中双荷包吻合术的应用研究  

Application of double-pouch anastomosis in laparoscopic radical resection of rectal cancer assisted by small incision

作　　者：尤小兰[1] 吴健[1] 王元杰[1] 赵小军[1] 周艳[2] 李文琦[3] 徐宁[1] 程之逸[1] 黄传江[1] 刘贵远[1] You Xiaolan;Wu Jian;Wang Yuanjie;Zhao Xiaojun;Zhou Yan;Li Wenqi;Xv Ning;Cheng Zhiyi;Huang Chuanjiang;Liu Guiyuan(Department of Gastrointestinal Surgery,Tai Zhou People's HospitaL,Jiangsu Taizhou225300,China;Department of Scientific research and teaching,Tai Zhou People's HospitaL,Jiangsu Taizhou225300,China;Department of Medical Quality and Safety,Tai Zhou People's HospitaL,Jiangsu Taizhou 225300,China)

机构地区：[1]江苏省泰州市人民医院胃肠外科,225300 [2]江苏省泰州市人民医院科研教学科,225300 [3]江苏省泰州市人民医院医疗质量与安全控制科,225300

出　　处：《中华胃肠外科杂志》2018年第12期1408-1413,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：中国博士后基金(2018M632400);泰州市科技支撑计划(社会发展)项目(TS201824).

摘　　要：目的探讨小切口辅助下腹腔镜直肠癌根治术中双荷包吻合术的可行性和安全性以及经济学效益。方法对2011年1月至2017年12月期间在江苏省泰州市人民医院胃肠外科接受手术治疗的224例原发性直肠腺癌患者的临床资料进行回顾性分析,病例纳入标准为术前肠镜病理明确诊断,肿瘤距肛缘4~15cm,行耻骨上小切口辅助腹腔镜全直肠系膜切除术(TME)。按术中吻合方式,分为双荷包单吻合器组(双荷包吻合组,108例)和单荷包双吻合器组(单荷包吻合组,116例),对两组患者的手术学指标、肿瘤安全性指标、近期疗效及经济学指标进行分析比较。结果双荷包吻合组与单荷包吻合组患者年龄、性别、腹部手术史、体质指数、美国医师协会评分(ASA评分)、肿瘤大小、肿瘤距肛缘距离、肿瘤病理分化程度、肿瘤TNM分期等基线资料比较,差异无统计学意义(均P>0.05)。两组手术时间、术中出血量、淋巴结清扫数目、切除肿瘤近端和远端肠管平均长度以及术后排尿功能障碍、性功能障碍、排粪功能异常发生率差异均无统计学意义(均P>0.05)。与单荷包吻合组相比,双荷包吻合组术后吻合口继发出血率低[0.9%(1/108)比6.0%(7/116),χ^2=4.238,P=0.040],术后吻合口漏发生率低[1.9%(2/108)比7.8%(9/116),χ^2=4.179,P=0.041],术后吻合口狭窄发生率低[1.9%(2/108)比8.6%(10/116),χ^2=5.054,P=0.025],且住院时间短[(13.4±3.9)d比(15.9±9.8)d,t=2.524,P=0.013],住院费用低[(3.4±0.7)万元比(4.6±2.3)万元,t=5.047,P<0.001]。平均随访33个月,两组患者术后局部复发率、远处转移率、总体生存率差异均无统计学意义(均P>0.05)。结论小切口辅助腹腔镜直肠癌TME术中行双荷包单吻合器吻合术安全、可行,并可降低住院费用。Objective To explore the feasibility,safety and the economical efficiency of double-pouch anastomosis in laparoscopic radical rectal cancer assisted by small incisions.Methods Clinical data of 224 patients undergoing gastrointestinal surgery at Taizhou People's Hospital of Jiangsu Province from January 2011 to December 2017 were retrospectively analyzed.Indusion criteria:patients were diagnosed as primary rectal adenocarcinoma by preoperative enteroscopy pathology,the distance of the tumor to anal margin was from 4 to 15cm,and patients were treated with laparoscopic total mesorectal excision (TME)through small incision.Patients were divided into two groups according to different anastomosis method,double-pouch group(108 cases)and single-pouch group (116 cases).The surgical indexes,tumor safety indexes,short-term efficacy and economic indexes were compared between the two groups.Results There was no significant difference between two groups in baseline data,operative time,blood loss,number of lymph nodes dissection,average length of proximal and distal bowel,or incidence of urination and sexual dysfunction (all P>0.05).Compared with the single-pouch group,the double-pouch group presented lower anastomotic secondary bleeding rate [0.9%(1/108)vs.6.0%(7/116),χ^2=4.238,P=0.040],lower incidence of anastomotic leakage [1.9%(2/108)vs.7.8%(9/116),χ^2=4.179,P=0.041],lower incidence of anastomotic stricture [1.9%(2/108)vs.8.6%(10/116),χ^2=5.054,P=0.025],shorter hospital stay [(13.4±3.9)days vs. (15.9±9.8)days,t=2.524,P=0.013]and less average hospitalization costs [(34000±7000)yuan vs. (46000±23000)yuan,t=5.047,P<0.001].There was no significant difference in local recurrence, distant metastasis or overall survival between the two groups during mean follow-up of 33 months (all P> 0.05).Conclusion Laparoscopic TME assisted by small incision with double-pouch anastomosis is a safe,feasible and economical method.

关 键 词：直肠肿瘤 腹腔镜手术 双荷包吻合 

分 类 号：R735.37[医药卫生—肿瘤]