中低位直肠癌经肛全直肠系膜切除术后短期并发症分析  

Short-term complications after transanal total mesorectal excision for mid-low rectal cancer

作　　者：许峰铭 安勇博 吴国聪[1] 张潇 姚宏伟[1] 张忠涛[1] Xu Fengming;An Yongbo;Wu Guocong;Zhang Xiao;Yao Hongwei;Zhang Zhongtao(Department of General Surgery,National Clinical Research Center for Digestive Diseases,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科国家消化系统疾病临床医学研究中心,北京100050

出　　处：《中华胃肠外科杂志》2022年第3期235-241,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家科技支撑计划课题(2015BAI13B09);国家重点研发计划资助(2017YFC0110904);北京市重点临床学科基金(2018-118);首都卫生发展科研重点项目(首发2018-1-1111);首都医科大学结直肠肿瘤临床诊疗与研究中心基金项目(1192070313);首都医科大学附属北京友谊医院科研启动基金(YYQDKT2016-5)。

摘　　要：目的总结和分析经肛全直肠系膜切除术(taTME)治疗中低位直肠癌的术后短期并发症。方法采用描述性病例系列研究方法,回顾性收集首都医科大学附属北京友谊医院普通外科2016年11月至2021年4月期间,连续性接受taTME治疗的83例中低位直肠癌患者病例资料,男58例(69.9%);年龄(61.4±11.8)岁;其中低位直肠癌42例(50.6%),中位直肠癌41例(49.4%)。术后短期并发症的定义为术后30 d内发生的并发症;Clavien-Dindo评分标准进行并发症分级同时将本组前40例与后43例患者的术后短期并发症发生率进行比较,以了解度过taTME学习曲线前后并发症发生率的差异。结果81例完成腹腔镜辅助taTME手术,中转开腹2例(2.5%)。有78例(94.0%)完成吻合,另外5例(6.0%)行永久性造口。经腹+经肛总手术时长(246.9±85.0)min,中位术中出血量100(IQR:100)ml。75例(96.2%,75/78)行预防性造口,其中74例行预防性回肠造口,1例行预防性横结肠造口;3例未行造口。术后30 d内并发症发生率为38.6%(32/83),出院后并发症发生率为8.4%(7/83)。轻度并发症占比31.3%(26/83),重度并发症占比7.2%(6/83),没有患者在术后30 d内死亡。吻合口漏发生率15.4%(12/78)。8例(9.6%)患者出院后因并发症再次入院。术后中位住院时间7(IQR:3)d。所有的轻度(Ⅰ+Ⅱ级)并发症患者均予以常规保守对症治疗。1例C级吻合口漏出现感染中毒性休克、多器官功能障碍,转入重症监护室并接受二次手术;2例Ⅲa级麻痹性肠梗阻患者行内镜下肠梗阻导管置入治疗;3例出现Ⅲ级及以上呼吸系统并发症,其中1例出现胸腔积液行B超引导下穿刺,2例呼吸衰竭的患者经抗感染及对症处理等治疗,好转出院;1例Ⅲb级泌尿系感染者急诊行输尿管支架植入。本组前40例患者术后出现并发症20例(50.0%),后43例术后并发症发生率显著降低(12例,27.9%),与前40例相比,差异有统计学意义(χ^(2)=4.270,P=0.039)。结论taTME�Objective To summarize short-term postoperative complications of transanal total mesorectal excision(taTME)in the treatment of middle-low rectal cancer.Methods A descriptive case series of cases was constructed.Clinical data of consecutive 83 patients with mid-low rectal cancer who received taTME treatment from November 2016 to April 2021 at Department of General Surgery of Beijing Friendship Hospital,Capital Medical University were collected.Among 83 patients,58(69.9%)were males,with a mean age of(61.4±11.8)years;42(50.6%)were low rectal cancer,41(49.4%)were middle rectal cancer.Short-term postoperative complication was defined as complication occurring within 30 days after operation.The complication was graded according to the Clavien-Dindo classification.At the same time,the morbidity of short-term postoperative complication in the first 40 patients and that in the last 43 patients were compared to understand the differences before and after passing the taTME learning curve.Results Two patients(2.5%)were converted to laparotomy;78(94.0%)completed anastomosis.While 5(6.0%)underwent permanent stoma.The total operation time of transabdominal+transanal procedure was(246.9±85.0)minutes,and the median intraoperative blood loss was 100(IQR:100)ml.Seventy-five cases(75/78,96.2%)underwent defunctioning stoma,including 74 cases of diverting ileostomy,1 case of diverting transverse colostomy and 3 cases without stoma.The morbidity of complication within 30 days after operation was 38.6%(32/83),and the morbidity of complication after discharge was 8.4%(7/83).Minor complications accounted for 31.3%(26/83)and major complications accounted for 7.2%(6/83).No patient died within 30 days after operation.The incidence of anastomotic leakage was 15.4%(12/78).Eight patients(9.6%)were hospitalized again due to complications after discharge.The median postoperative hospital stay was 7(IQR:3)days.All the patients with minor(I-II)complications received conservative treatment.One patient with grade C anastomotic leakage was transferr

关 键 词：直肠癌 经肛全直肠系膜切除 并发症 短期 

分 类 号：R735.37[医药卫生—肿瘤]