折刀位与截石位行直肠癌腹会阴联合切除术近期疗效的比较研究  

Comparison of the short-term outcomes of abdominoperineal resection for rectal cancer between folding knife position and lithotomy position

作　　者：王海锋 刘江 王刚[2] 赵健 胡加伟 江志伟 WANG Hai-feng;LIU Jiang;WANG Gang(Department of General Surgery,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China;Jiangsu Province Hospital of Chinese Medicine)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院),江苏南京210002 [2]江苏省中医院

出　　处：《腹腔镜外科杂志》2019年第3期212-216,共5页Journal of Laparoscopic Surgery

基　　金：国家自然科学基金项目(81500417);江苏省科委社会发展基金(BE2015687)

摘　　要：目的:探讨采用折刀位与截石位行腹会阴联合切除术治疗低位直肠癌的近期临床疗效。方法:回顾分析2013年2月至2017年10月接受腹会阴联合切除术的低位直肠癌患者的临床资料,其中59例先取折刀位行会阴部手术,后改平卧位行腹部手术(折刀组),53例以传统截石位行会阴部及腹部手术(截石组)。对比分析两组手术情况、术后恢复及并发症发生情况。结果:与截石组相比,折刀组术中会阴部出血量少[(57.62±29.24) mL vs.(78.13±32.68) mL],术后引流管拔除时间短[(5.15±1.73) d vs.(5.91±1.75) d],术后住院时间短[7(6,9) d vs. 8(7,12) d],术后会阴部切口并发症发生率低(5.08%vs.15.09%),差异有统计学意义(P<0.05);两组手术时间、术中腹部出血量、术中并发症发生率、术后3 d卧床时疼痛评分、术后首次下床活动时间、经口进半流质饮食时间、结肠造口排气时间、腹部切口并发症发生率差异无统计学意义(P>0.05)。结论:与截石位相比,折刀位可更好地暴露手术区域,确切止血,降低会阴部切口并发症发生率,促进术后恢复,手术效果较好,可考虑优先采用。Objective:To explore the short-term clinical efficacy of abdominoperineal resection in folding knife position and lithotomy position in the treatment of low rectal cancer.Methods:The clinical data of low rectal cancer patients who underwent abdominoperineal resection from Feb.2013 to Oct.2017 were retrospectively analyzed.Among them,59 patients underwent perineal surgery at the folding knife position,then underwent abdominal surgery at the supine position(folding knife group),and 53 patients underwent perineal and abdominal surgery at the traditional lithotomy position(lithotomy group).The operation conditions,postoperative recovery and complications of the two groups were compared and analyzed.Results:Compared with lithotomy group,the perineal bleeding volume in the folding knife group was less[(57.62±29.24)mL vs.(78.13±32.68)mL],the drainage tube removal time was shorter[(5.15±1.73)d vs.(5.91±1.75)d],the postoperative hospital stay was shorter[7(6,9)d vs.8(7,12)d],and the incidence of perineal incision complications was lower(5.08%vs.15.09%),the differences were significant(P<0.05).There were no significant differences in the operation time,amount of abdominal bleeding during operation,incidence of complications during operation,pain score in 3 d after operation,time of first ambulation after operation,time of semi-liquid diet,time of colostomy exhaust or incidence of abdominal incision complications(P>0.05).Conclusions:Compared with the lithotomy position,the folding knife position can better expose the surgical area,reduce the incidence of perineal incision complications,promote the recovery after operation,and achieve better surgical results,hemostasis is accurate.The folding knife position should be given priority.

关 键 词：直肠肿瘤 经腹会阴联合切除术 折刀位 截石位 疗效比较研究 

分 类 号：R735.37[医药卫生—肿瘤]