改良生物补片重建盆底腹膜在腹腔镜Miles手术中应用的临床研究  

A clinical study of modified biological patch for reconstruction of pelvic floor peritoneum in laparoscopic Miles surgery

作　　者：王文琛 袁浩 朱学章 张继准 孔帅[1,2] 田锋 苗瑞政 靖昌庆[1,2] 李乐平 徐涛[1,2] Wang Wenchen;Yuan Hao;Zhu Xuezhang;Zhang Jizhun;Kong Shuai;Tian Feng;Miao Ruizheng;Jing Changqing;Li Leping;Xu Tao(Department of Gastrointestinal Surgery,Shandong Provincial Hospital,Cheeloo College of Medicine,Shandong University,Shandong Jinan 250023,China;Department of Gastrointestinal Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Shandong Jinan 250023,China)

机构地区：[1]山东大学附属省立医院胃肠外科,山东济南250023 [2]山东第一医科大学附属省立医院胃肠外科,山东济南250023

出　　处：《腹部外科》2020年第6期434-438,444,共6页Journal of Abdominal Surgery

基　　金：国家自然科学基金(81702363);山东省重点研发计划(2019GSF108161)。

摘　　要：目的探讨改良生物补片重建盆底腹膜(modified biological patch for reconstruction of pelvic floor peritoneum,MBR)用于腹腔镜Miles手术的安全性和临床效果。方法回顾性分析2015年1月至2018年12月在山东省立医院胃肠外科接受腹腔镜Miles手术的343例低位直肠癌病人的临床资料。按纳入和排除标准,303例病人纳入研究,根据是否行MBR,将病人分为MBR组(47例)和未重建(Non-MBR)组(256例)。研究中使用的生物补片取材于牛心包组织,是一种交联脱细胞基质材料。比较两组的术中和术后结果,并介绍MBR方法和安全性。结果与Non-MBR组相比,MBR组术后粘连性小肠梗阻(adhesive small bowel obstruction,ASBO)的发生率降低(0比10.9%,P<0.05),术后因ASBO的再次住院率降低(0比9.8%,P<0.05)。Non-MBR组术后因ASBO平均再次住院次数为1.8次。MBR组重建盆底腹膜时间为(3.3±0.8)min,该组病人随访1年未出现生物补片排异、感染、侵蚀、磨损等不良反应。两组手术时间、术中出血量、术后首次排气时间、术后住院时间、会阴切口液化、感染、会阴疝的发生率、因会阴切口感染、会阴疝的再次住院率差异无统计学意义。结论MBR在腹腔镜Miles手术中安全易行、耗时较少,可降低术后ASBO的发生率及因ASBO再住院率。此外,交联脱细胞基质材料生物补片具有良好的组织相容性,具有临床实用价值。Objective To introduce the safety and clinical effect of modified pelvic peritoneum reconstruction with biological patch(MBR)for laparoscopic abdominal perineal resection(Miles),and compare this new method with surgery that does not reconstruct the pelvic peritoneum(Non-MBR).Methods The clinical data of 343 patients with low rectal cancer who underwent laparoscopic Miles surgery in the Department of Gastroenterology,Shandong Provincial Hospital from January 2015 to December 2018 were analyzed retrospectively.According to the inclusion and exclusion criteria,303 patients were included in the study,47 patients were treated with laparoscopic Miles and MBR,and 256 patients were only treated with laparoscopic Miles,which were divided into MBR group and Non-MBR group separately.The biological patch is derived from bovine pericardial tissue and it is a cross-linked acellular matrix material.The intraoperative and postoperative results of the two groups were compared,and the process and safety of pelvic floor peritoneal reconstruction with modified biological patch were introduced.Results Compared with Non-MBR group,the incidence of adhesive small bowel obstruction(ASBO)in MBR group was lower(0 vs.10.9%,P<0.05).The rehospitalization rate of MBR group decreased due to ASBO after operation(0 vs.9.8%,P<0.05).In Non-MBR group,the average number of rehospitalization due to ASBO was 1.8 times.The average time of MBR was(3.3±0.8)minutes.No adverse reactions such as biological patch rejection,infection,erosion and wear were found in MBR group after follow-up for 1 year.There was no significant difference in operation time,intraoperative blood loss,first postoperative exhaust time,postoperative hospital stay,perineal incision liquefaction or infection,incidence of perineal hernia,rehospitalization rate of perineal incision infection and perineal hernia between the two groups(P>0.05).Conclusion MBR is a safe,easy and time-saving method in laparoscopic Miles surgery.It can reduce the risk of ASBO and the risk of readmission becaus

关 键 词：盆底腹膜重建 防粘连屏障 粘连性小肠梗阻 腹腔镜腹会阴联合切除术 

分 类 号：R657.1[医药卫生—外科学]