测量骶骨岬至直肠残端的距离在腹腔镜直肠癌根治术精准吻合中的应用价值  

The application value of measuring the distance between the sacral promontory to the rectal stump in accurate anastomosis of laparoscopic radical rectal cancer resection

作　　者：郑波波 屈亚琦 张松 岳育民 厍豪 汪光柱 董胜璞 邱健[1] 王小强[1] Zheng Bobo;Qu Yaqi;Zhang Song;Yue Yumin;She Hao;Wang Guangzhu;Dong Shengpu;Qiu Jian;Wang Xiaoqiang(Department of General Surgery,Shannxi Province People's Hospital,Xi'an 710068,China)

机构地区：[1]陕西省人民医院普外一科,西安710068

出　　处：《中华结直肠疾病电子杂志》2021年第2期144-148,共5页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：陕西省重点研发计划(No.2021SF-128)。

摘　　要：目的评估术中精确测量直肠残端至骶骨岬的距离(Drp)在腹腔镜直肠癌手术精准吻合中的应用价值。方法纳入陕西省人民医院普外科2019年1月1日到2020年10月1日连续入院的并接受择期腹腔镜手术的中低位直肠癌病例39例,收集临床病例资料并回顾手术视频;术中测量步骤如下:使用线段测量Drp;拉展左半结肠及其系膜至骶骨岬水平,使用钛夹标记相应结肠为A点;以A点为起点,以原Drp线段测量A点以远Drp+3 cm处为直肠癌近端切除线。行结直肠端端吻合,经肛留置肛管行肠腔内减压,新辅助放化疗术后病例行末段回肠造口,评价指标包括术中,术后及标本质量三方面;本研究采用描述性统计方法。结果手术时间(247±57)min,估计术中出血量(35±15)m L。吻合前游离脾区结肠7例;吻合后盆腔结肠无"悬空架桥"的病例;无吻合后游离近端结肠及再次裁剪系膜的病例;远切缘距肿瘤下缘的距离(2.3±1.1)cm,Drp(17.7±4.6)cm,近切端距肿瘤上缘的距离(16.4±3.2)cm,直肠全系膜切除的标本质量均为A级,直肠癌远近切缘无阳性病例;术后无B、C级吻合口漏发生,吻合口出血1例;肛管排气时间(3.1±1.2)天,排便时间(3.4±1.6)天,术后住院时间(9.1±2.3)天。结论测量Drp能够精确地确定拟吻合结肠的长度,促进腹腔镜根治性直肠癌切除术的精准吻合。Objective To evaluate the value of intraoperative accurate measurement of the distance from the distal rectal edge to the promontory of the sacrum(Drp)in accurate anastomosis of laparoscopic rectal cancer surgery.Methods Thirty-nine patients with low-middle rectal cancer undergoing laparoscopic surgery who were admitted to General Surgery Department of Shannxi Provincial People’s Hospital from January 1,2019 to October 1,2020 were included.Clinical data were collected and surgical videos were reviewed.Intraoperative measurement was performed as follows:Line segment was used to measure the Drp;The left semicolon and its mesangium were stretched at the level of the promonium of the sacrum and A titanium clip was used to mark the corresponding colon as point A;Starting from point A,the original Drp line segment was used to measure the proximal resection line of rectal cancer from point A to Drp+3 cm.Colorectal end-to-end anastomosis was performed,and enteral decompression was performed through anal indwelling anal canal.Patients underwent terminal ileostomy after neoadjuvant chemoradiotherapy.The evaluation indexes include intraoperative,postoperative and specimen quality.Descriptive statistical methods were used in this study.Results The operative time was(247±57)min,and the intraoperative blood loss was estimated at(35±15)m L.The splenic flexure of the colon was mobilized before anastomosis in 7 cases.Therewere no cases of pelvic colon"bridging"after anastomosis,and the pelvic colon was relaxed after anastomosis through the anterior sacral area.There were no cases of free proximal colon after anastomosis and the mesangium was trimmed again.The Drp(17.7±4.6)cm,the distance from the proximal resection margin was(16.4±3.2)cm,and the distance from the distal resection margin was(2.3±1.1)cm.The specimen quality of total rectal mesorectal resection was grade A.There were no positive cases at the distal resection margin of rectal cancer.There was no anastomotic leakage after surgery.One patient had anastomotic ble

关 键 词：直肠肿瘤 骶骨岬 直肠残端 距离 吻合 

分 类 号：R735.37[医药卫生—肿瘤]