改良式抵钉座绑线反穿法在结直肠经自然腔道取标本手术消化道重建中的应用  

Modified Reverse Cabling Tie Anvil Insertion in Digestive Tract Reconstruction of Colorectal Natural Orifice Specimen Extraction Surgery

作　　者：段吉清 张路遥[1] 孙东辉[1] Duan Jiqing;Zhang Luyao;Sun Donghui(Department of Gastrointestinal Surgery,First Bethune Hospital,Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学白求恩第一医院胃肠外科,长春130021

出　　处：《中国微创外科杂志》2019年第1期42-45,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜下改良式抵钉座绑线反穿吻合器吻合的技术优势。方法回顾分析我科2016年10月～2018年2月92例结直肠癌经自然腔道取标本手术(natural orifice specimen extraction surgery,NOSES)的临床资料,根据消化道重建方式不同分成2组:A组56例,消化道重建时采用改良式抵钉座绑线反穿吻合器吻合; B组36例,采用传统荷包缝合抵钉座吻合。比较2组手术时间,术中出血量及术后恢复情况。结果 92例均顺利完成手术,A组手术时间明显短于B组[(133. 1±14. 3) min vs.(154. 0±19. 1) min,t=5. 634,P=0. 000];术后吻合口漏发生率明显低于B组[0%(0/56) vs. 11. 1%(4/36),Fisher精确检验,P=0. 021]。A、B组术中出血量分别为(49. 4±9. 2)、(52. 9±9. 1) ml,无统计学差异(t=1. 799,P=0. 075);术后首次排气时间分别为(2. 6±0. 9)、(2. 9±1. 0) d,无统计学差异(t=1. 857,P=0. 067);术后住院时间分别为(8. 0±1. 3)、(8. 1±2. 6) d,无统计学差异(t=0. 162,P=0. 872)。结论改良式抵钉座绑线反穿法完成结直肠NOSES简单快捷,比传统荷包缝合抵钉座法具有明显优势。Objective To investigate technical advantages of laparoscopic modified reverse cabling tie anvil insertion anastomosis. Methods A retrospective analysis was made on clinical data of 92 patients with colorectal cancer who underwent natural orifice specimen extraction surgery (NOSES) in our hospital from October 2016 to February 2018.They were divided into two groups according to the different ways of digestive tract reconstruction:56 cases in group A were given the method of modified reverse cabling tie anvil insertion in the digestive tract reconstruction and 36 cases in group B were given traditional method of pursing string suture anvil.The operation time,intraoperative bleeding,and postoperative recovery were compared between the two groups. Results The surgery was successfully completed in all the 92 patients.The operation time of group A was less than group B [(133.1±14.3) min vs.(154.0±19.1) min,t=5.634,P=0.000] and the incidence of postoperative anastomotic leakage of group A was lower than group B [0%(0/56) vs.11.1%(4/36),Fisher’s test,P=0.021].There were no significant differences between the two groups in the intraoperative bleeding [(49.4±9.2) ml vs.(52.9±9.1) ml,t=1.799,P=0.075],the postoperative time to return of flatus [(2.6±0.9) d vs.(2.9±1.0) d,t=1.857,P=0.067],and the postoperative hospital stay [(8.0±1.3) d vs.(8.1±2.6) d,t=0.162,P=0.872]. Conclusion Colorectal NOSES by using the method of modified reversing cabling tie anvil insertion anastomosis has advantage of simple performance,superior to traditional method of pursing string suture anvil.

关 键 词：抵钉座绑线反穿法 消化道重建 结直肠癌 

分 类 号：R735.34[医药卫生—肿瘤]