改良Bacon术式一次性手术治疗超低位直肠癌  

Modified Bacon surgery for one-time operation in treatment of ultra-low rectal cancer

作　　者：唐寄焱 苏锦松 张炜[1] 张茂润 米纪元 王世豪 宋军民[1] TANG Jiyan;SU Jinsong;ZHANG Wei;ZHANG Maorun;MI Jiyuan;WANG Shihao;SONG Junmin(Department of Colorectal and Anal Surgery,The First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,P.R.China)

机构地区：[1]郑州大学第一附属医院结直肠肛门外科,郑州450052

出　　处：《中国普外基础与临床杂志》2021年第10期1308-1313,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：2021年度河南省高等学校重点科研项目计划(项目编号:21A310019)。

摘　　要：目的评估改良Bacon术式一次性手术在腹腔镜超低位直肠癌根治术中应用的安全性和优势。方法回顾性分析2018年8月至2020年6月期间在郑州大学第一附属医院结直肠肛门外科宋军民教授医疗组收治的所有行腹腔镜直肠癌改良Bacon术式患者的临床病理资料。根据术中手术方式分为改良Bacon一次性手术组(简称"改良组")和Bacon二次手术组(简称"传统组"),比较2组患者的围术期及随访情况。结果本研究共收集到59例患者,其中改良组26例,传统组33例,2组患者的性别构成、年龄等基线资料比较差异均无统计学意义(P>0.05)。2组患者均顺利完成手术,无中转开腹,无围术期死亡病例,无术中或术后大出血、重度感染等严重并发症或麻醉相关并发症,改良组未发生吻合口漏、传统组有6例发生吻合口漏(P<0.05),2组患者的吻合口出血、吻合口狭窄、直肠刺激征、外置肠管坏死发生率比较差异无统计学意义(P>0.05)。2组患者的手术时间、术中出血量、清扫淋巴结总数、术后首次排气时间及术后住院时间比较差异均无统计学意义(P>0.05)。2组患者术后第3和6个月时发生直肠低位前切除术综合征(LARS)的严重程度及总评分比较差异均无统计学意义(P>0.05),但2组术后第6个月时的LARS总评分均分别低于同一组内第3个月(P<0.001)。截止到末次随访时间(2021年1月),2种手术后肛门外形随时间变化总体来看差异不大,效果均令人满意,随访期间均无肿瘤复发和死亡病例。结论改良Bacon一次性手术安全、可行,可实现经自然腔道取标本,更加微创地实现超低位极限保肛,能降低术后吻合口漏及外置肠管坏死的发生率,减少了手术次数,相应可能缩短总住院时间和降低住院总费用。Objective To evaluate the safety and advantages of modified Bacon one-time operation in laparoscopic radical resection for ultra-low rectal cancer.Methods The medical records of all patients who underwent laparoscopic modified Bacon procedure for ultra-low rectal cancer treated by Professor SONG Junmin Medical Group of our department from August 2018 to June 2020 were analyzed retrospectively.According to the different methods during the operation,the patients were divided into a modified Bacon one-time operation group(modified Bacon group,n=26)and a Bacon secondary operation group(traditional Bacon group,n=33).The perioperative period data and follow-up results were observed and compared.Results A total of 59 ptients were collected,including 26 cases in the modified Bacon group and 33 cases in the traditional Bacon group.There were no significant differences in gender composition,age,etc.baseline data between the two groups(P>0.05).All surgery were successfully completed.There were no conversion to laparotomy,intraoperative or postoperative massive bleeding,severe infection and other serious complications and perioperative period death.The incidence of anastomotic leakage in the modified Bacon group was lower than that of the traditional Bacon group[0.0%(0/26)versus 18.2%(6/33),P=0.030].There were no significant differences in the incidences of postoperative anastomotic bleeding,anastomotic stricture,rectal irritation,and external intestinal necrosis between the two groups(P>0.05).And the number of dissected lymph nodes,operation time,intraoperative blood loss,the first exhaust time,and postoperative hospital stay had no significant differences between the two groups(P>0.05).There were no significant differences in the severity degree and total score of low anterior rectectomy syndrome(LARS)between the two groups at 3 and 6 months after operation(P>0.05).However,the total LARS score at 6 months after operation was lower than that at 3 months in the same group(P<0.001).By the end of the last follow-up(January 202

关 键 词：改良Bacon一次性术式 直肠癌 超低位保肛 

分 类 号：R735.37[医药卫生—肿瘤]