吻合口加固缝合预防腹腔镜中低位直肠癌前切除术后吻合口漏的临床研究  

Effect of anastomotic reinforcement suture on the incidence of anastomotic fistula after laparoscopic surgery for low and middle rectal cancer

作　　者：金从稳 王勇[1] 傅赞 JIN Congwen;WANG Yong;FU Zan(Department of Colorectal Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院结直肠外科,江苏南京210029

出　　处：《徐州医科大学学报》2022年第2期110-114,共5页Journal of Xuzhou Medical University

基　　金：江苏省高层次卫生人才“六个一工程”拔尖人才科研项目(LGY2017073);江苏省第四期“333工程”科研项目(BRA2015473)。

摘　　要：目的探讨吻合口加固缝合对腹腔镜中低位直肠癌前切除术后吻合口漏及其他并发症的影响。方法选择2018年3月—2020年12月于南京医科大学第一附属医院结直肠外科治疗的中低位直肠癌患者,共计258例。根据手术方式将123例采用腹腔镜直肠前切除术+吻合口加固缝合患者设为观察组,135例只采用腹腔镜直肠前切除术的患者设为对照组。比较患者的临床资料、术后炎症指标和并发症的发生率。结果与对照组相比,观察组的首次排气时间、首次下床活动时间、胃肠功能恢复时间、术后住院时间均显著降低,差异有统计学意义(P<0.05);手术时间和SF-36评分显著升高,差异有统计学意义(P<0.05)。术后炎症指标方面,观察组术后白细胞(WBC)、中性粒细胞(Neu)、单核细胞(Mon)、淋巴细胞(Lym)和C-反应蛋白(CRP)均显著低于对照组,差异有统计学意义(P<0.05)。观察组的术后并发症总发生率显著低于对照组,其中观察组中吻合口漏和切口感染的发生率显著低于对照组(P<0.05),差异有统计学意义。结论吻合口加固缝合降低了腹腔镜中低位直肠癌术后吻合口漏的发生率,值得推广。Objective To investigate the effect of anastomotic reinforcement suture on the incidence and complications of anastomotic leakage after laparoscopy for middle and low rectal cancer.Methods A total of 258 patients with middle and low rectal cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University from March 2018 to December 2020 were selected.According to the operation methods,123 patients with laparoscopic anterior rectectomy and anastomotic reinforcement suture were set as an observation group,while 135 patients receiving laparoscopic anterior rectectomy alone were set as a control group.Both groups were compared for their clinical data,postoperative inflammatory indicators and complication incidence.Results Compared with the control group,the observation group presented remarkable decreases in the time to first anal exhaust,the time to first out-of-bed activity,the recovery time of gastrointestinal function,and the length of hospitalization stay(P<0.05).For postoperative inflammatory indicators,the observation group showed significantly lower counts of white blood cells,neutrophils,monocytes and lymphocytes and C-reactive protein levels than the control group(P<0.05).The total incidence of postoperative complication in the observation group was remarkably lower than that in the control group,where lower incidences of anastomotic leakage and incision infection were found in the observation group(P<0.05).Conclusions Anastomotic reinforcement suture can reduce the incidence of anastomotic leakage after laparoscopy for middle and low rectal cancer,which is worthy of promotion.

关 键 词：中低位直肠癌 吻合口漏 腹腔镜下直肠前切除术 

分 类 号：R735.37[医药卫生—肿瘤]