腹腔镜直肠前切除术中远切端三种处理方式的对比研究  

Comparative study of three treatment methods of distal incision margin in laparoscopic rectal anterior resection

作　　者：刘鹏飞 钱正海 吴云云 吴建忠 吴传福 黄维贤 LIU Peng-fei;QIAN Zheng-hai;WU Yun-yun(Department of Gastrointestinal Surgery,Suzhou Ninth People’s Hospital,Suzhou 215200,China)

机构地区：[1]苏州市第九人民医院苏州大学附属苏州九院胃肠外科,江苏苏州215200

出　　处：《腹腔镜外科杂志》2022年第8期573-578,共6页Journal of Laparoscopic Surgery

摘　　要：目的:探讨乙状结肠癌、直肠癌行腹腔镜直肠前切除术中远切端三种处理方式对临床结果的影响。方法:回顾分析2016年1月至2020年12月行腹腔镜直肠前切除术患者的临床资料,经纳入、排除标准筛选后共入组102例,按术中远切端处理方式分为3组,A组(n=26)采用单吻合器结合经自然腔道取标本手术(NOSES),B组(n=41)采用双吻合器结合NOSES,C组(n=35)采用传统双吻合器结合辅助切口。对比分析三组患者术中、术后指标,探讨三种远切端处理方式的优缺点。结果:3组术中出血量差异无统计学意义(P>0.05),手术时间、术后排气时间、术后疼痛评分、术后住院时间、住院总费用、吻合口并发症发生率、切口感染发生率差异有统计学意义(P<0.05)。结论:三种处理方式均安全、可靠,单吻合器结合NOSES与双吻合器结合NOSES创伤更小,有助于术后更快康复,切口感染率低,术后疼痛轻,单吻合器结合NOSES的处理方式能减少吻合器的使用,降低费用,但是否有助于降低吻合口并发症发生率尚存有争议。Objective:To investigate the effects of three different treatments of distal incision edge in laparoscopic rectal anterior resection for sigmoid and rectal cancer on clinical results.Methods:The clinical data of the patients who underwent laparoscopic rectal anterior resection from Jan.2016 to Dec.2020 were retrospectively analyzed.A total of 102 patients were included according to the inclusion and exclusion criteria.These patients were divided into three groups based on the treatment of distal edge,group A(n=26)underwent single stapler combined with natural orifice specimen extraction surgery(NOSES);group B(n=41)received double-stapler combined with the NOSES;group C(n=35)underwent operation with traditional double-stapler combined with the auxiliary incision.The intraoperative and postoperative indicators of the three groups were compared,and the advantages and disadvantages of the three treatment methods for distal incision edge were discussed through statistical analysis.Results:There was no significant difference in i ntraoperative blood loss among the three groups(P>0.05).There were statistically significant differences among the three groups in the duration of operation,postoperative exhaust time,postoperative pain score,postoperative hospital stay,total hospitalization cost,incidence of anastomotic complications and incidence of incision infection(P<0.05).Conclusions:The three kinds of treatment were safe and reliable,NOSES with single and double-stapler is mini-invasive and helpful for fast recovery,reduced incision infection and postoperative pain.Single stapler combined with NOSES can reduce the use of stapler,reduce the cost,however,whether it can reduce the incidence of anastomotic complications remains controversial.

关 键 词：直肠肿瘤 乙状结肠肿瘤 直肠前切除术 腹腔镜检查 远切端处理 

分 类 号：R735.34[医药卫生—肿瘤]