小切口辅助腹腔镜全直肠系膜切除术不同吻合方式的临床效果比较  

Comparison of different anastomotic methods in small incision-assisted laparoscopic total mesorectal excision for patients with primary rectal adenocarcinoma

作　　者：殷洁烽[1] 林聪利 张喆[1] YIN Jiefeng;LIN Congli;ZHANG Ze(Department of General Surgery,Tongde Hospital of Zhengjiang Province,Hangzhou 310012,China)

机构地区：[1]浙江省立同德医院普外科

出　　处：《浙江医学》2019年第11期1183-1186,1190,共5页Zhejiang Medical Journal

摘　　要：目的比较小切口辅助腹腔镜全直肠系膜切除术(TME)不同吻合方式的临床效果。方法回顾性分析75例原发性直肠腺癌患者的临床资料,所有患者行耻骨上小切口辅助腹腔镜TME,乙状结肠与直肠吻合时采取单荷包双吻合器方式37例、双荷包单吻合器方式38例。比较两组患者临床指标、术后并发症情况、肿瘤根治性指标及预后情况。结果与单荷包双吻合器组比较,双荷包单吻合器组患者住院时间更短,住院费用更低,差异均有统计学意义(均P<0.05);两组患者在手术时间、术中出血量、术后肠功能恢复时间、排尿及性功能障碍、排便功能异常等方面比较,差异均无统计学意义(均P>0.05)。双荷包单吻合器组吻合口出血、吻合口漏、吻合口狭窄发生率均明显低于单荷包双吻合器组(均P<0.05);两组患者非计划二次手术比例比较,差异无统计学意义(P>0.05)。两组患者清扫淋巴结数、肠管远端及近端切缘长度比较,差异均无统计学意义(均P>0.05)。双荷包单吻合器组、单荷包双吻合器组患者3年总生存率分别为87.40%、81.10%,差异无统计学意义(P>0.05)。结论与单荷包双吻合器方式比较,小切口辅助腹腔镜TME中采取双荷包单吻合器方式的临床效果确切,能减少患者住院时间及治疗费用,降低术后吻合口相关并发症发生率。Objective To compare the clinical efficacy of different intraoperative anastomotic methods in small incision-assisted laparoscopic total mesorectal excision(TME)for patients with primary rectal adenocarcinoma.Methods The clinical data of 75 patients with primary rectal adenocarcinoma were retrospectively analyzed.All patients were treated with laparoscopic TME through suprapubic small incision,during the operation single pouch suturing double stapling technique was performed in 37 cases(single pouch group)and double pouch suturing single stapling technique was performed in 38 cases(double pouch group).The clinical indexes,postoperative complications,tumor radical resection indexes and prognosis between the two groups were compared.Results Comparison with the single pouch group,the patients in the double pouch group presented shorter length of hospital stay and lower hospitalization expenses,(all P<0.05).There were no significant differences in operation time,intraoperative blood loss,the postoperative intestinal function recovery time,voiding and sexual dysfunction,defecation dysfunction between two groups(all P>0.05).The incidences of anastomotic bleeding,anastomotic leakage and anastomotic stricture in the double pouch group were significantly lower than those in the single pouch group(all P<0.05).There were no significant differences in the proportion of unplanned secondary surgery,number of lymph node dissection and the length of distal and proximal incision margin of intestine(all P>0.05).The 3-year overall survival rate of double pouch group and single pouch group was 87.40%and81.10%,respectively(P>0.05).Conclusion Compared with the single pouch suturing double stapling technique,the clinical efficacy of double pouch suturing single stapling technique can shorten hospitalization time,reduce treatment cost and the incidence of postoperative anastomotic related complications for patients with primary rectal adenocarcinoma undergoing laparoscopic TME.

关 键 词：单荷包吻合 双荷包吻合 双吻合器 单吻合器 原发性直肠腺癌 

分 类 号：R735.37[医药卫生—肿瘤]