两种消化道重建方式对腹腔镜低位直肠癌根治术后吻合口愈合的影响比较  

Comparison of the influence on the healing of anastomotic stoma between two kinds of alimentary canal reconstruction after laparoscopic radical resection of low rectal cancer

作　　者：王博智 李廷坚[1] 翁少涛 陈钊城 Wang Bozhi Li Tingjian Weng Shaotao Chen Zhaocheng(Department of General Surgery,the Second People＇s Hospital of Shantou , Shantou , Fujian 515000, China)

机构地区：[1]汕头市第二人民医院普通外科,广东省汕头515000

出　　处：《中国基层医药》2016年第21期3276-3279,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：探讨两种消化道重建方式对低位直肠癌患者行腹腔镜直肠癌根治术术后吻合口愈合的影响。方法回顾分析2013年7月至2016年1月因患Ⅱ～Ⅲ期低位直肠癌而行腹腔镜直肠癌根治术患者的临床资料，通过调阅病案，剔除其中患糖尿病、低蛋白血症、营养不良、存在肠梗阻而术前无法纠正的及行新辅助放化疗病例，依据消化道重建方式分为经腹处理组34例（其中低位直肠癌26例，超低位直肠癌8例，Ⅱ期直肠癌21例，Ⅲ期直肠癌13例），经肛门改良吻合组25例（其中低位直肠癌18例，超低位直肠癌7例，Ⅱ期直肠癌20例，Ⅲ期直肠癌5例），分析两种吻合方式对术后患者吻合口愈合情况的影响。结果所有病例均未出现吻合口狭窄，34例经腹处理组中出现吻合口漏1例，吻合口出血3例；25例经肛门改良吻合组出现吻合口漏2例，吻合口出血2例。经肛门改良吻合组与经腹处理组在吻合口漏及吻合口出血发生例数差异均无统计学意义（3例比2例，1例比2例，χ2＝0．13、0．75，均 P ＞0．05）。所有患者经治疗后均痊愈出院。结论两种吻合方式各有优缺点，通过术前、术中对肿瘤状态科学评估，合理选择肿瘤处理和吻合方式，更有利于术后患者恢复。Objective To investigate the different influencing on the healing of anastomotic stoma between two kinds of alimentary canal reconstruction after laparoscopic radical resection of low rectal cance.Methods The clinical data of July 2013 -January 2016 suffering from stage Ⅱ -Ⅲ low rectal cancer and in our hospital underwent laparoscopic colorectal cancer radical surgery patients was retrospectively analyzed.Through accessing to medical records,the patients of diabetes,hypoproteinemia,malnutrition,preoperative uncorrectable cases and received neoadjuvant therapy were excluded.More than a total of 59 cases were enrolled,34 cases of them received traditional alimentary canal reconstruction（traditional group,including 26 cases of low rectal cancer,8 cases of super low rectal cancer,also 21 cases of them in stageⅡand 13 cases in stage Ⅲ）,25 cases of them received anal anastomosis resection （including 18 cases of low rectal cancer,7 cases of super low rectal cancer,also 20 cases of them in stage Ⅱ and 5 cases in stageⅢ）.Results In the traditional group,1case of 34 patients with anastomotic leakage,3 cases of anastomotic bleeding, while in the improved group,2cases of 25 patients with anastomotic leakage,2 cases of anastomotic bleeding.There was no significant difference in the incidence of anastomotic leakage and anastomotic bleeding between the two groups （3cases vs.2cases,1case vs.2cases,χ2 =0.13,0.75,all P 〉0.05）.All cases did not occur in patients with anastomotic stenosis,and all patients were cured and discharged.Conclusion Each of the two methods have their advantages and disadvantages.Through preoperative,intraoperative evaluation of tumor status,reasonable choice of tumor treatment and anastomosis,is more conducive to postoperative recovery.

关 键 词：直肠肿瘤 直肠结肠切除术 重建性 腹腔镜检查 外科吻合口 

分 类 号：R735.37[医药卫生—肿瘤]