3D腹腔镜无切口与小切口直肠前切除术腹腔冲洗液培养结果分析  

Analysis of results of peritoneal lavage culture by 3D laparoscopic without incision and laparoscopy-assisted anterior resection of rectal cancer

作　　者：江期鑫[1] 傅传刚[1] 韩俊毅[1] 周主青[1] 高玮[1] 朱哲[1] 鹿鑫 张振宇 Jiang Qixin;Fu Chuangang;Han Junyi;Zhou Zhuqing;Gao Wei;Zhu Zhe;Lu Xin;Zhang Zhenyu(Department of Colcrectal Surgery,The Affiliated East Hospital,Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院胃肠肛肠外科,上海200120

出　　处：《腹部外科》2020年第4期301-305,共5页Journal of Abdominal Surgery

基　　金：上海市浦东新区卫生系统重点专科建设资助(PWZzk2017-26)。

摘　　要：目的对比关节镜保护套进行3D腹腔镜无切口与小切口直肠前切除术腹腔冲洗液培养结果情况。方法纳入2017年11月至2018年6月期间同济大学附属东方医院胃肠肛肠外科连续收治入院、接受手术治疗的高位直肠和乙状结肠癌病人,根据病人术前评估情况及病人意愿分为经自然腔道取标本手术(NOSES)组和小切口组,分别实施3D腹腔镜下NOSES或小切口根治性直肠前切除术,收集术后病人腹水标本进行细菌及真菌培养,并统计分析两组临床病理特征差异。结果NOSES组共纳入有效病例26例,小切口组共纳入有效病例34例。腹腔冲洗液培养结果显示,NOSES组有2例病人细菌培养结果阳性,培养出细菌分别为屎肠球菌、粪肠球菌及阴沟肠杆菌;小切口组有1例病人细菌培养结果阳性,培养出细菌为粪肠球菌、阴沟肠杆菌。两组真菌培养结果均为阴性。另外,NOSES组病人肿瘤距离肛缘距离、切除肿瘤最长径及pT分期均显著小于小切口组,但两组在病人性别、年龄、肿瘤组织学、分化程度、脉管神经浸润及pN分期方面差异均无统计学意义。结论在应用关节镜保护套建立标本取出通道后,NOSES手术不会增加腹腔内污染的概率。Objective To analyze the results of peritoneal washings culture in 3D laparoscopic non-incision and small incision anterior rectal resection by arthroscopic protective sheath.Methods Patients with high rectal and sigmoid colon cancer who were consecutively admitted to the Department of Gastrointestinal and Anorectal Surgery,Shanghai Oriental Hospital,Tongji University from November 2017 to June 2018 were enrolled and divided into NOSES small incision group according to preoperative evaluation and patients′willings.3D laparoscopic NOSES or small incision radical anterior proctectomy was performed.Postoperative ascites samples were collected for bacterial and fungal culture.The differences in clinicopathologic characteristics between the two groups were statistically analyzed.Results A total of 26 valid cases were included in the NOSES group and 34 valid cases were included in the small incision group.The results of peritoneal washings culture in the two groups showed that the bacterial culture results of 2 patients with NOSES surgery were positive,and the bacteria were Enterococcus faecium,Enterococcus faecalis and Enterobacter cloacae,respectively.One patient with small incision surgery had positive bacterial culture results,and bacteria Enterococcus faecalis and Enterobacter cloacae were cultured.Fungal cultures were negative in both groups.In addition,the distance from the tumor to the anal verge,the longest diameter of the resected tumor,and the pT stage were significantly smaller in the NOSES group than in the small incision group,but there was no significant difference in gender,age,tumor histology,differentiation,vascular nerve invasion,and pN stage between the two groups.Conclusion The NOSES procedure does not increase the probability of intra-abdominal contamination after the arthroscopic protective sheath has been used to channel specimen extraction.

关 键 词：直肠乙状结肠癌 3D腹腔镜 关节镜保护套 标本经直肠拖出手术 腹腔冲洗液 

分 类 号：R657.1[医药卫生—外科学]