折刀位对低位直肠癌腹会阴联合切除术预后的影响  

Effect of prone jackknife position on prognosis of abdominoperineal resection

作　　者：潘华峰 刘江 成汇 王海锋 王刚 龚冠闻[1] 柳欣欣 江志伟 Huafeng Pan;Jiang Liu;Hui Cheng;Haifeng Wang;Gang Wang;Guanwen Gong;Xinxin Liu;Zhiwei Jiang(Department of General Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210002,China;Department of General Surgery,Jinling Hospital Affiliated to Nanjing Medical University,Nanjing 210002,China)

机构地区：[1]南京中医药大学附属医院,江苏省中医院普通外科,210002 [2]南京医科大学附属金陵医院普外科,210002

出　　处：《中华结直肠疾病电子杂志》2022年第6期482-488,共7页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：江苏省中医药管理局重点项目(ZD201903);江苏省中医药局开放项目(JD201807);江苏省中医院院级课题(k2019ycx25)。

摘　　要：目的评估折刀位能否减少经腹会阴联合切除术(APR)的常见并发症,改善长期生存。方法回顾性分析2010年1月~2016年10月在南京军区总医院接受APR的148例低位直肠癌患者的临床资料,根据手术体位的不同分为折刀位组和截石位组,从术中出血、手术时间、切口感染、术后尿潴留、环周切缘、5年生存率等方面,比较两种体位对患者预后的影响。结果折刀位组术中出血更少(t=-5.683,P=0.000),手术时间更短(t=-3.885,P=0.000),会阴部切口感染率(χ^(2)=4.425,P=0.035)、术后尿潴留发生率(χ^(2)=6.321,P=0.012)及环周切缘阳性率更低(χ^(2)=4.199,P=0.040),5年总生存率相对更高(log-rank=3.880,P=0.049)。结论相对于截石位,折刀位可能更有利于改善APR短期及长期预后。Objective To evaluate whether prone jackknife position could reduce the common complications and improve the long-term survival of APR.Methods From January 2010 to October 2016,a retrospective analysis for the clinical data of 148 patients undergone APR in Jinling Hospital was performed.According to the operation position,patients were divided into prone jackknife group and lithotomy group.The intraoperative bleeding,operation time,incision infection,urinary retention,circumferential cutting edge,the 5-year survival rate and so on,were compared to explore the influence of operation position on the prognosis of patients.Results The prone jackknife group showed less intraoperative bleeding(t=-5.683,P=0.000),shorter operation time(t=-3.885,P=0.000),lower rate of perineal incision infection(χ^(2)=4.425,P=0.035),postoperative urinary retention(χ^(2)=6.321,P=0.012)and positive circumferential incision margin(χ^(2)=4.199,P=0.040),and higher 5-year overall survival rate(log-rank=3.880,P=0.049).Conclusion Compared with lithotomy position,prone jackknife position may be more beneficial to improve the short-term and long-term prognosis of APR.

关 键 词：直肠肿瘤 经腹会阴联合切除术 手术体位 术后并发症 短期预后 5年生存率 

分 类 号：R735.37[医药卫生—肿瘤]