盆底腹膜重建联合快速康复外科在机器人直肠癌TME手术中的近期疗效  

Short-term outcomes of using pelvic peritoneum reconstruction with enhanced recovery in robotic-assisted surgery for total mes-orectal excision of rectal cancer

作　　者：王赫 吕耀春[2] 路继永 王帅 张云强 王涛[2] 杜斌斌[2] 张维胜[2] 杨熊飞[2] Wang He;Lyu Yaochun;Lu Jiyong;Wang Shuai;Zhang Yunqiang;Wang Tao;Du Binbin;Zhang Weisheng;Yang Xiongfei(Gansu Provincial Hospital,Lanzhou 730000,China)

机构地区：[1]甘肃中医药大学,甘肃兰州730000 [2]甘肃省人民医院,甘肃兰州730000

出　　处：《甘肃医药》2020年第11期961-965,共5页Gansu Medical Journal

基　　金：甘肃省自然科学基金(项目编号:18JR3RA055);甘肃省青年科技基金(项目编号:17JR5RA031);甘肃省人民医院院内科研项目(项目编号:20GSSY3-1)。

摘　　要：目的:探讨盆底腹膜重建联合快速康复外科(ERAS)在达芬奇机器人直肠癌全系膜切除术(TME)中的应用及近期临床疗效。方法:回顾性分析2018年1月至2020年1月于我院肛肠科接受常规机器人手术治疗方案或术中盆底腹膜重建联合ERAS治疗的患者105例,根据治疗和手术方式不同分为观察组和对照组,观察组47例,采用术中盆底腹膜重建联合ERAS行机器人直肠癌TME手术;对照组58例,采用常规机器人手术治疗方案行机器人直肠癌TME手术,比较两组患者围术期和随访情况。结果:两组患者均顺利完成手术。观察组术后排气时间、流质饮食时间、术后下床活动时间、腹腔引流拔管时间、术后住院时间均短于对照组(P<0.05);且观察组术后疼痛评分小于对照组(P<0.05);但观察组手术时间多于对照组(P<0.05)。观察组术前空腹血糖维持效果优于对照组(P<0.05)。两组患者术后炎性指标较术前均有所升高,但与对照组相比,观察组术后IL-6、PCT和WBC升高水平较低,炎症反应控制效果较好(P<0.05)。两组病理学分型、病理学分级和AJCC分期均无统计学差异(P>0.05);两组术后并发症发生率无统计学差异(P>0.05)。术后随访两组患者均无肿瘤复发,未见腹腔感染、迟发性吻合口漏、造口坏死或造口疝等严重并发症。结论:盆底腹膜重建联合ERAS应用于机器人直肠癌TME手术,可以加速胃肠道功能恢复、缓解疼痛、提高免疫水平、减轻炎症应激反应。Objective:To investigate the application and short-term outcomes of using pelvic peritoneum reconstruction with enhanced recovery(ERAS)in robotic-assisted surgery for total mesorectal excision for rectal cancer.Methods:A total of 105 patients diagnosed with rectal cancer from January 2018 to January 2020 were analyzed retrospectively.According to the different treatment and operation methods,they were divided into two groups,the study group(47 cases),which used pelvic peritoneum reconstruction combined with ERAS to perform robotic-assisted TME surgery for rectal cancer.58 cases in the control group were treated with conventional robotic-assisted surgery.The perioperative period and follow-up data of the two groups were compared.Results:Both groups successfully completed the operation.Postoperative exhaust time,fluid diet time,postoperative ambulation time,abdominal drainage and extubation time and postoperative hospital stay time in the observation group were shorter than those in the control group(P<0.05);Postoperative pain score was lower than that of the control group(P<0.05);However,the operation time of the observation group was longer than that of the control group(P<0.05).The maintenance effect of fasting glucose in the observation group was better than that in the control group(P<0.05).Postoperative inflammatory indicators in both groups were higher than that before surgery,but compared with the control group,the observation group had lower postoperative IL-6,PCT and WBC levels,and better inflammatory response control(P<0.05).There were no statistically significant differences in the pathological typing,grading,and AJCC staging between the two groups(P>0.05);There was no statistical difference in the incidence of postoperative complications between the two groups(P>0.05).No tumor recurrence was found in the 2 groups during postoperative follow-up,and no serious complications such as abdominal infection,delayed anastomotic leakage,stoma necrosis or stoma hernia were found.Conclusion:Pelvic peritoneum recon

关 键 词：直肠癌 快速康复外科 盆底腹膜重建 近期疗效 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]