带蒂结肠浆肌袖套鞘术在预防腹腔镜直肠癌前切除术后吻合口漏中的应用研究  

Application study of sheath technique with seromuscular sleeve of pedicled colon in preventing anastomotic leakage following laparoscopic anterior resection of rectal cancer

作　　者：郭彪[1] 李向国[1] 胡明高[1] GUO Biao;LI Xiangguo;HU Minggao(Department of General Surgery,The PLA Navy Anqing Hospital,Anqing,Anhui 246003,P.R.China)

机构地区：[1]中国人民解放军海军安庆医院普通外科,安徽安庆246003

出　　处：《中国普外基础与临床杂志》2021年第9期1182-1187,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨带蒂结肠浆肌袖套鞘术在腹腔镜直肠癌前切除术中预防吻合口漏的价值。方法回顾性收集2017年1月至2020年3月期间在笔者所在医院普外科行腹腔镜直肠癌前切除术患者的临床资料,根据手术方式不同分为带蒂结肠浆肌袖套鞘术组(简称袖套鞘术组)和传统手术组。比较2组患者的手术时间、术中出血量、术后通气时间、术后住院时间、住院费用、术后吻合口漏及复发情况。结果本研究共纳入87例患者,袖套鞘术组37例,传统手术组50例,2组患者的性别、年龄、体质量指数(BMI)、术前合并疾病、肿瘤下缘距肛缘距离、肿瘤组织学分型、新辅助治疗和TNM分期基线资料比较差异无统计学意义(P>0.05);在术中出血量、清扫淋巴结数目、术后肛门首次排气时间和住院费用方面比较差异均无统计学意义(P>0.05);袖套鞘术组手术时间长于传统手术组,术后住院时间短于传统手术组,差异均有统计学意义(P<0.05);袖套鞘术组与传统手术组术后吻合口漏发生率分别为0.0%(0/37)、12.0%(6/50),差异有统计学意义(P<0.05);2组患者术后吻合口狭窄、淋巴漏和切口感染发生情况比较差异均无统计学意义(P>0.05)。术后所有患者均完成随访,随访时间6~36个月,中位随访时间21个月,无复发及死亡病例。结论带蒂结肠浆肌袖套鞘术可增加吻合口的抗张力能力,降低术后吻合口漏的发生率,是一种安全有效的手术方式。Objective To study feasibility of sheath technique with seromuscular sleeve of pedicled colon in preventing anastomotic leakage following laparoscopic anterior resection of rectal cancer.Methods The clinical data of patients who underwent laparoscopic anterior resection of rectal cancer in our hospital from January 2017 to March 2020 were retrospectively collected.According to different surgical methods,they were divided into two groups:pedicled seromuscular sleeve sheath group(referred to as sleeve sheath operation group)and traditional operation group.The intraoperative and postoperative statuses were compared between these two groups.Results In this study,87 patients with rectal cancer were included,37 in the sleeve sheath operation group and 50 in the traditional operation group.There were no significant differences in the baseline data such as the gender,age,body mass index(BMI),complicating disease,distance from lower tumor margin to anal verge,histological classification,neoadjuvant radio-chemotherapy,and TNM stage between the two groups(P>0.05).There were no significant differences in the volumes of intraoperative blood loss,the number of lymph node dissection,the first postoperative anal exhaust time and the hospitalization expense between the two groups(P>0.05).Compared with the traditional operation group,the operative time of the sleeve sheath operation group was longer(P<0.05),the postoperative hospitalization time of the sleeve sheath operation group was shorter(P<0.05).The incidence of postoperative anastomotic leakage in the sleeve sheath operation group and the traditional group were 0.0%(0/37)and 12.0%(6/50),respectively,and the difference was statistically significant(P<0.05).There were no significant differences in the anastomotic stenosis,the lymphatic fistula and the incision infection between the two groups(P>0.05).All patients were followed-up for 6 to 36 months,with a median time of 21 months.No recurrence or death occurred.Conclusion The sheath technique with seromuscular sleeve of pedic

关 键 词：直肠癌 带蒂结肠 浆肌袖 吻合口漏 

分 类 号：R735.37[医药卫生—肿瘤]