经肛加固缝合吻合口在腹腔镜超低位直肠癌保肛手术中的疗效分析  

Effectiveness of transanal reinforced anastomosis in laparoscopic sphincter-pre⁃serving operation for ultra-low rectal cancer

作　　者：张海[1] 陈述[1] 张进[1] 周庆[1] 徐三荣[1] Zhang Hai;Chen Shu;Zhang Jin;Zhou Qing;Xu Sanrong(Department of General Surgery,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,Jiangsu,China)

机构地区：[1]江苏大学附属医院普外科,江苏镇江212001

出　　处：《结直肠肛门外科》2021年第6期560-563,共4页Journal of Colorectal & Anal Surgery

基　　金：江苏大学临床专项基金(JDLCZX013)。

摘　　要：目的探讨经肛加固缝合吻合口在腹腔镜超低位直肠癌保肛手术中的疗效。方法选取2018年1月至2020年1月于我院行腹腔镜超低位直肠癌保肛手术的58例患者作为研究对象,根据吻合后是否加固缝合吻合口分为经肛加固缝合吻合口组(n=26)和未加固缝合吻合口组(n=32)。比较两组患者的围手术期指标(手术时间、术中出血量、胃肠道功能恢复时间)、术后1个月内并发症(盆腔感染、吻合口出血、吻合口漏及吻合口狭窄)发生情况及肛门功能恢复情况。结果经肛加固缝合吻合口组手术时间长于未加固缝合吻合口组(P<0.05);两组术中出血量、胃肠道功能恢复时间比较差异均无统计学意义(均P>0.05)。经肛加固缝合吻合口组吻合口漏发生率低于未加固缝合吻合口组(P<0.05);两组盆腔感染、吻合口出血及吻合口狭窄发生率比较差异均无统计学意义(均P>0.05)。术后随访12个月,两组肛门功能在术后1个月开始逐渐恢复,但不同时间点肛门功能比较差异均无统计学意义(均P>0.05)。结论经肛加固缝合吻合口可有效降低腹腔镜超低位直肠癌保肛手术患者的吻合口漏发生率,不影响术后肛门功能恢复,具有临床推广的价值。Objectives To investigate the effectiveness of transanal reinforced anastomosis in laparoscopic sphincter-preserving operation for ultra-low rectal cancer.Methods Fifty-eight patients who received laparoscopic sphincter-preserving operation for ultra-low rectal cancer at our hospital between January 2018 and January 2020 were recruited.Patients were divided into rein⁃forced group(n=26,receiving transanal reinforced anastomosis)and non-reinforced group(n=32,not receiving transanal reinforced anastomosis).Duration of surgery,intraoperative blood loss,time to gastrointestinal function recovery,complications within one month after surgery(pelvic infection,anastomotic bleeding,anastomotic leakage,anastomotic stricture),and anal function recovery were compared between the two groups.Results Duration of surgery was significantly longer in the reinforced group than in the non-reinforced group(P<0.05).The two groups were similar in intraoperative blood loss and time to gastrointestinal function re⁃covery(P>0.05).The incidence of anastomotic leakage was significantly lower in the reinforced group than in the non-reinforced group(P<0.05).The incidence of pelvic infection,anastomotic bleeding,and anastomotic stricture was similar between the two groups(P>0.05).Patients were followed up for 12 months.In both groups,anal function gradually recovered within one month af⁃ter surgery,and anal function was similar at different time points between the two groups(P>0.05).Conclusion Transanal rein⁃forced anastomosis can decrease the risk of anastomotic leakage in laparoscopic sphincter-preserving operation for ultra-low rec⁃tal cancer while not influencing anal function recovery.It has the potential for broader clinical application.

关 键 词：超低位直肠癌 保肛手术 经肛加固缝合吻合口 吻合口漏 肛门功能 

分 类 号：R735.37[医药卫生—肿瘤]