脐上纵行辅助切口在腹腔镜直肠癌手术中应用的优势探讨  

Vertical supraumbilical incision versus left lower oblique incision for specimen retrieval during laparoscopic rectal surgery

作　　者：骆洋[1] 俞旻皓[1] 陈建军[1] 秦骏[1] 崔然[1] 黄轶洲 钟鸣[1] Luo Yang;Yu Minhao;Chen Jianjun;Qin Jun;Cui Ran;Huang Yizhou;Zhong Ming(Department of Gastrointestinal Surgery,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,200127

出　　处：《中华胃肠外科杂志》2020年第3期289-293,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81672347、81802308)。

摘　　要：目的探讨脐上纵行辅助切口在腹腔镜直肠癌手术中应用的优势。方法采用回顾性队列研究方法。病例纳入标准:(1)电子结肠镜及病理学检查诊断为直肠癌;(2)首次接受手术治疗;(3)同一治疗组完成的腹腔镜直肠癌根治术;(4)年龄>18岁,<76岁。根据以上标准,收集2015年3月至2017年12月期间,上海仁济医院胃肠外科收治的行腹腔镜直肠癌手术并经病理确诊的178例直肠癌患者的临床资料,根据手术采用的腹部切口方式不同,分为左下腹斜行切口组(103例)和脐上纵行切口组(75例)。两组年龄、性别、体质指数、肿瘤长径、术前癌胚抗原水平、美国麻醉医师协会评分以及肿瘤TNM分期等基线资料的比较,差异均无统计学意义(均P>0.05)。比较两组术中、术后及并发症发生情况。结果脐上纵行切口组与左下腹斜行切口组在手术时间[(131.7±3.7)min比(138.5±3.5)min]、术中出血量[(138.9±11.5)ml比(154.3±10.3)ml]、术中切口长度[(4.0±0.1)cm比(4.0±0.1)cm]以及吻合口距齿状线距离[(3.8±0.1)cm比(4.2±0.1)cm]方面比较,差异均无统计学意义(均P>0.05)。相比左下腹斜行切口组,脐上纵行切口组患者术后首次通气时间[(62.7±2.3)h比(69.2±1.7)h,t=2.282,P=0.023]和首次下床活动时间[(41.9±1.8)h比(46.8±1.4)h,t=2.131,P=0.032]均较早,术后24 h和48 h视觉模拟评分较低[24 h时:(2.0±0.1)分比(2.4±0.1)分,t=2.172,P=0.032;48 h时:(2.7±0.1)分比(3.0±0.1)分,t=2.432,P=0.012],术后切口疝的发生率也较低[6.7%(5/75)比9.7%(10/103),χ2=3.942,P=0.042],但两组术后进流质饮食时间、住院天数、术后12 h内的视觉模拟评分以及其他术后并发症(包括伤口感染、吻合口漏、尿潴留和肠梗阻)发生率的差异均无统计学意义(均P>0.05)。结论腹腔镜直肠癌手术脐上纵行切口可降低患者术后疼痛指数,有利于患者术后早期肠道功能的恢复,同时可以降低切口疝的发生率,有临床推广价值。Objective To compared the short-term surgical outcomes of the vertical supraumbilical incision with the left lower oblique incision for specimen retrieval in laparoscopic resection for rectal cancer.Methods A retrospective cohort study was performed.Inclusion criteria:(1)rectal cancer confirmed by colonoscopy and pathological examination;(2)undergoing the operation for the first time;(3)laparoscopic rectal surgery performed by the same surgeon team;(4)age of>18 years and<76 years old.According to above criteria,clinical data of 178 consecutive patients scheduled for laparoscopic surgery for rectal cancer at Department of Gastrointestinal Surgery of Renji Hospital between March 2015 and December 2017 were collected.Based on incision site of the mini-laparotomy,patients were classified to the vertical supraumbilical incision group(n=75)and the left lower oblique incision group(n=103).There were no significant differences in baseline data,such as age,gender,body mass index(BMI),tumor diameter,preoperative carcinoembryonic antigen(CEA)level,score of American Society of Anesthesiologists,TNM stage,between the two groups(all P>0.05).Perioperative variables and follow-up data were compared between two groups.Results Between the vertical supraumbilical incision group and the left lower oblique incision group,the operation time[(131.7±3.7)minutes vs.(138.5±3.5)minutes],operative bleeding volume[(138.9±11.5)ml vs.(154.3±10.3)ml],length of auxiliary incision[(4.0±0.1)cm vs.(4.0±0.1)cm],and distance from anastomosis to dentate line[(3.8±0.1)cm vs.(4.2±0.1)cm]were not significantly different(all P>0.05).As compared to the left lower oblique incision group,patients in vertical supraumbilical incision group had earlier flatus[(62.7±2.3)hours vs.(69.2±1.7)hours,t=2.282,P=0.023],earlier ambulation[(41.9±1.8)hours vs.(46.78±1.42)hours,t=2.131,P=0.032],lower pain VAS scores at postoperative 24 hours(2.0±0.1 vs.2.4±0.1,t=2.172,P=0.032)and 48 hours(2.7±0.1 vs.3.0±0.1,P<0.05),and lower incidence of postoperative incisi

关 键 词：直肠肿瘤 腹腔镜手术 脐上纵行切口 左下腹斜行切口 疼痛指数 切口疝 

分 类 号：R735[医药卫生—肿瘤]