腹腔镜辅助直肠癌根治术中支架法肠道转流术预防吻合口漏九例临床分析  

Clinical analysis of 9 cases of a novel stent assisted intestinal bypass for preventing anastomotic leakage in laparoscopic assisted radical resection of rectal cancer

作　　者：吴仲禺 宋章法[2] 童一凡 张新杰 王一帆[3] 黄学锋[2] 蔡秀军[3] Wu Zhongyu;Song Zhangfa;Tong Yifan;Zhang Xinjie;Wang Yifan;Huang Xuefeng;Cai Xiujun(Department of Surgical Oncology,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310020,China;Department of Anus&Intestine Surgery,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310020,China;Department of General Surgery,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310020,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院肿瘤外科,杭州310020 [2]浙江大学医学院附属邵逸夫医院肛肠外科,杭州310020 [3]浙江大学医学院附属邵逸夫医院普外科,杭州310020

出　　处：《中华外科杂志》2021年第6期497-501,共5页Chinese Journal of Surgery

基　　金：浙江省卫健委省部共建重大项目(WKJ-ZJ-1904)。

摘　　要：目的探讨腹腔镜辅助直肠癌根治术中采用支架法肠道转流术预防吻合口漏的效果。方法回顾性分析2019年9月至2020年6月于浙江大学医学院附属邵逸夫医院肛肠外科接受腹腔镜辅助直肠癌根治术+支架法肠道转流术的9例直肠癌患者的临床资料。男性6例,女性3例,年龄(62.1±6.8)岁(范围:53~75岁)。完成腹腔镜辅助直肠癌根治术后在回肠末端置入可降解支架,支架近端置入转流管以转流肠道内容物。术后患者少渣饮食,术后第14天起定期拍摄腹部X线片动态观察支架崩解情况,待X线片确认支架崩解,并通过转流管造影确认无吻合口漏后可夹闭转流管,3 d后无明显不适可拔除转流管。记录患者的手术时间、术后拔除转流管时间、住院时间等围手术期资料。结果所有患者成功实施腹腔镜辅助直肠癌根治术+支架法肠道转流术。手术时间为(230.4±48.0)min(范围:150~318 min),术后拔除转流管时间(28.8±4.6)d(范围:22~34 d),住院时间(21.0±8.6)d(范围:9~34 d)。术后病理学检查结果示中分化腺癌7例,中高分化腺癌1例,黏液腺癌1例;T1期2例,T2期4例,T3期3例。淋巴结清扫数目(13.4±3.5)枚(范围:6~18枚),淋巴结转移阳性3例,阴性6例。术后随访时间为6~16个月,未发生吻合口漏或吻合口狭窄。结论支架法肠道转流术可用于腹腔镜辅助直肠癌根治术中吻合口漏的预防,近期效果较好。Objective To examine the safety and effectiveness of a novel stent assisted intestinal bypass for preventing anastomotic leakage in laparoscopic assisted radical resection of rectal cancer.Methods The clinical data of 9 patients with rectal cancer who underwent laparoscopic radical resection and stent assisted intestinal bypass from September 2019 to June 2020 at the Department of Anus&Intestine Surgery,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University were retrospectively analyzed.There were 6 males and 3 females,aged(62.1±6.8)years(range:53 to 75 years),underwent laparoscopic assisted radical resection of rectal cancer and stent assisted intestinal bypass.A degradable diverting stent was placed at the end of the ileum,and a drainage tube was placed at the proximal end of the stent to bypass the intestinal contents.After operation,the patients were given a diet with less residue.From the 14th day after operation,abdomen X-ray films were taken every 5 to 7 days to observe the destination of the stent dynamically.When the stent was observed to be disintegrated into pieces,the drainage tube was clamped for 3 days to observe any side effects before the tube was removed.The operation time,the time of removing the bypass tube and the total hospital stay were recorded.Results Laparoscopic assisted radical resection of rectal cancer and stent assisted intestinal bypass were successfully performed in all patients.The operation time was(230.4±48.0)minutes(range:150 to 318 minutes),and the time of removing shunt tube was(28.8±4.6)days(range:22 to 34 days).The duration of hospitalization was(21.0±8.6)days(range:9 to 34 days).Postoperative pathological examination showed 7 cases of moderately differentiated adenocarcinoma,1 case of moderately well differentiated adenocarcinoma and 1 case of mucinous adenocarcinoma.There were 2 cases of T1,4 cases of T2 and 3 cases of T3.The number of lymph node dissection was 13.4±3.5(range:6 to 18),3 cases were positive and 6 cases were negative.The post-operation follow

关 键 词：直肠肿瘤 回肠造口术 支架 吻合口瘘 

分 类 号：R735.37[医药卫生—肿瘤]