经肛全直肠系膜切除术中困难或意外及术后并发症发生情况调查报告(一项基于全国性登记数据库的研究)  

Intraoperative difficulties/accidents and postoperative complications of transanal total mesorectal excision:A nationwide registry study

作　　者：李杨[1] 任明扬[2] 张宏宇[3] 王权[4] 徐庆[5] 于刚[6] 陈建志 张宏[8] 肖毅[9] 吴淼[10] 魏鹏宇 刘怡杉 姚宏伟[1] 张忠涛[1] LI Yang;REN Ming-yang;ZHANG Hong-yu(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Clinical Practice and Research Center for Colorectal Neoplasm,Capital Medical Uni-versity,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,首都医科大学结直肠肿瘤临床诊疗与研究中心,北京100050 [2]川北医学院南充中心医院胃肠外科,四川南充637900 [3]重庆医科大学附属第一医院胃肠外科,重庆400042 [4]吉林大学第一医院胃肠外科,吉林长春130021 [5]上海交通大学医学院附属仁济医院胃肠外科,上海200127 [6]淄博市临淄区人民医院结直肠外科,山东淄博255200 [7]中国台北和信治癌中心医院外科 [8]中国医科大学附属盛京医院结直肠肿瘤外科,辽宁沈阳110004 [9]北京协和医院基本外科,北京100730 [10]宜宾市第二人民医院胃肠疝外科,四川宜宾644000

出　　处：《中国实用外科杂志》2022年第11期1260-1264,共5页Chinese Journal of Practical Surgery

基　　金：国家重点研发计划资助(No.2017YFC0110904);北京市临床重点专科基金(No.2018-118);首都医科大学结直肠肿瘤临床诊疗与研究中心专项基金(No.1192070313);首都医科大学附属北京友谊医院科研启动基金(No.YYQDKT2016-5)。

摘　　要：目的分析中国经肛全直肠系膜切除(taTME)手术病例登记数据库中登记的taTME术中困难或意外及术后并发症发生情况,为安全实施taTME手术提供数据支持。方法基于真实世界研究的理念,通过回顾性及前瞻性收集并分析2017-11-15至2022-06-30来自全国43家中心登记录入中国taTME病例登记协作研究数据库(CTRC)的1926例taTME手术病例,统计分析taTME术中困难或意外及术后并发症发生情况。结果1926例taTME手术病例中,男性病人占68.9%,中位年龄61(53~68)岁。34.3%的手术中遇到中困难或意外,其中盆腔术野烟雾发生率为22.3%,不稳定的盆腔CO_(2)灌注压发生率为18.0%。taTME术后并发症总发生率15.4%。术后吻合口漏发生率为5.9%,其中B级发生率2.2%。术后发热82例(4.3%),术后发生肠梗阻41例(2.1%),术后发生尿潴留29例(1.5%),术后发生切口并发症15例(0.8%)。结论最常见的术中困难是盆腔术野烟雾及不稳定的盆腔CO_(2)灌注压;术后并发症按发生率由高至低依次为吻合口漏(B级最常见)、术后发热、肠梗阻、尿潴留、切口感染等。为进一步降低其发生率,taTME手术的结构化培训不可或缺。Objective To introduce the intraoperative difficulties/accidents and postoperative complications of transanal total mesorectal excision(taTME)based on the data registered in the Chinese taTME Registry Collaborative(CTRC).Methods Between November 15,2017,and June 30,2022,clinical data of 1,926 patients undergoing taTME procedure registered in the CTRC database from 43 domestic centers were collected retrospectively.The occurrence of difficulties/accidents and postoperative complications in taTME surgery were statistically analyzed.Results(1)1926 cases of taTME were included in the analysis of this study.There were 1327 males(68.9%)and 599 females(31.1%)with median age of 61(53~68)years old;(2)34.3%of the patients encountered intraoperative difficulties/accidents,among which the most common intraoperative problems were pelvic operation field smoke(22.3%)and unstable pelvic CO_(2)perfusion pressure(18.0%);(3)The postoperative complications occurred in 296 cases(15.4%).Anastomotic leakage was the most common complication,with an incidence of 5.9%,among which Grade B anastomotic leakage(2.2%)was the most common.The incidence of postoperative fever was 4.3%(82/1,926).Intestinal obstruction occurred in 41 cases(2.1%).Urinary retention occurred in 29 cases(1.5%).15 cases(0.8%)developed wound complications.Conclusion The most common intraoperative difficulties were pelvic surgical field smoke and unstable pelvic CO_(2)perfusion pressure;Postoperative complications,in order of incidence from highest to lowest,were anastomotic leakage(Grade B most common),postoperative fever,ileus,urinary retention,incision infection and etc.To further reduce problems/accidents and postoperative complications in taTME surgery,structured training on taTME surgery is indispensable.

关 键 词：直肠癌 经肛全直肠系膜切除 中国经肛全直肠系膜切除病例登记协作研究数据库 术中意外 并发症 登记研究 

分 类 号：R6[医药卫生—外科学]