经肛覆膜支架预防腹腔镜低位直肠癌术后吻合口并发症的应用体会  

Application experience of transanal membrane-covered stent in preventing anastomotic complications after laparoscopic low rectal cancer surgery

作　　者：张遥 刘鼎盛[1] 崔明明[1] 张宏[1] ZHANG Yao;LIU Ding-sheng;CUI Ming-ming(Department of Colorectal Neoplasms Surgery,Shengjing H ospital of China Medical University,Shenyang 117004,China)

机构地区：[1]中国医科大学附属盛京医院结直肠肿瘤外科,辽宁沈阳117004

出　　处：《腹腔镜外科杂志》2022年第10期752-757,共6页Journal of Laparoscopic Surgery

基　　金：辽宁省民生科技计划项目(2021JH2/10300053)。

摘　　要：目的:探讨经肛覆膜支架预防腹腔镜低位直肠癌手术后吻合口并发症的效果。方法:回顾分析2018年9月至2020年10月行腹腔镜低位直肠癌全直肠系膜切除术的124例患者的临床资料,按是否留置经肛覆膜支架分为支架组(n=59)与对照组(n=65),对比分析两组术后炎症指标变化、吻合口漏与吻合口狭窄发生率、住院费用等相关指标。结果:两组患者临床资料具有可比性(P>0.05)。术后第5天、第7天,支架组白细胞、C反应蛋白、降钙素原低于对照组,差异有统计学意义(P<0.05)。支架组术后未发生吻合口漏,对照组发生2例(3.08%),两组吻合口漏发生率差异无统计学意义(P>0.05)。支架组术后吻合口狭窄发生率为3.39%(2/59),对照组为4.62%(3/65),差异无统计学意义(P>0.05)。支架组住院总费用平均(66528.5±3573.2)元,对照组平均(65684.0±3500.9)元,两组差异无统计学意义(P>0.05)。结论:经肛覆膜支架应用于腹腔镜低位直肠癌手术可有效降低炎症反应,促进术后吻合口的愈合。Objective:To study the effect of transanal membrane-covered stent in preventing anastomotic complications after laparoscopic surgery for low rectal cancer.Methods:Clinical data of 124 patients who underwent laparoscopic total mesorectal resection from Sep.2018 to Oct.2020 were retrospectively analyzed.Patients were divided into stent group(n=59)and control group(n=65)according to whether the transanal membrane-covered stent was indwelled or not.The changes of postoperative inflammatory index,i ncidence of anastomotic leakage and anastomotic stenosis,and the hospitalization expenses between the two groups were analyzed and compared.Results:The general clinical data of the two groups were comparable(P>0.05).The inflammatory indexes of white blood cells,C-reactive protein and procalcitonin in stent group were lower than those in control group on the 5th and 7th day after the operation,and the differences were statistically significant(P<0.05).The incidence of anastomotic leakage was 0%(0/59)in the stent group,and 3.08%(2/65)in the control group,the difference was not statistically significant(P>0.05).The incidence of anastomotic stenosis was 3.39%(2/59)in the stent group,and 4.62%(3/65)in the control group,the difference was not statistically significant(P>0.05).The hospitalization expenses of the stent group was(66528.5±3573.2)yuan,and the control group was(65684.0±3500.9)yuan,the difference was not statistically significant(P>0.05).Conclusions:The application of transanal membrane-c overed stent in laparoscopic low rectal cancer surgery can effectively reduce the inflammatory response and promote postoperative anastomotic healing.

关 键 词：低位直肠肿瘤 腹腔镜检查 覆膜支架 吻合口漏 吻合口狭窄 

分 类 号：R735.37[医药卫生—肿瘤]