经直肠拖出标本的腹腔镜高位直肠前切除术中两种抵钉座置入方法的对比研究  

Hetao method and purse-string forceps method of insertion of anvil in natural orifice specimen extraction surgery with CRC-Ⅳtype:A comparative study

作　　者：冯春在[1] 陈宏[1] 孙浩 钟思权 叶少炜 周仕海[1] Feng Chunzai;Chen Hong;Sun Hao;Zhong Siquan;Ye Shaowei;Zhou Shihai(Department of Tumor Surgery,Zhongshan City People’s Hospital,Zhongshan 528403,China)

机构地区：[1]广东省中山市人民医院肿瘤外科,528403

出　　处：《中华普通外科学文献（电子版）》2023年第2期119-123,共5页Chinese Archives of General Surgery(Electronic Edition)

基　　金：中山市社会公益与基础研究项目(医疗卫生一般项目)(2020B1082)。

摘　　要：目的探讨“荷套法”和“荷包钳法”两种抵钉座置入方法在腹部无辅助切口经直肠拖出标本的腹腔镜高位直肠前切除术(CRC-NOSESⅣ式)中的安全性和优缺点。方法选取2019年1月至2022年9月中山市人民医院行CRC-NOSESⅣ式腹腔镜高位直肠前切除术的103例乙状结肠癌、高位直肠癌患者为研究对象,根据抵钉座置入方法不同,分为荷套组63例和荷包钳组40例,分别进行荷套法和荷包钳法两种抵钉座置入。比较两组手术时间、抵钉座置入时间、术中出血量、术后恢复情况和并发症发生情况。结果荷包钳组抵钉座置入时间明显短于荷套组,差异有统计学意义[(8.9±2.2)min vs(13.9±2.3)min,t=10.908,P<0.001],两组手术时间、术中出血量、术后下床活动时间、术后排气时间、术后住院时间差异无统计学意义。两组吻合口漏、肠梗阻、吻合口出血、腹腔出血、腹腔感染及总并发症发生率差异无统计学意义。结论荷套法和荷包钳法两种抵钉座置入方法各有优缺点,在CRC-NOSESⅣ式腹腔镜高位直肠前切除术中的应用均安全可靠,且手术并发症及术后恢复情况相似,值得尝试和推广。Objective To compare the safety,advantages and disadvantages of Hetao method and purse-string forceps method of insertion of anvil in laparoscopic high anterior rectal resection without auxiliary abdominal incision(CRC-NOSESⅣtype).Methods From January 2019 to September 2022,103 patients with sigmoid colon cancer or high rectal cancer who underwent laparoscopic high anterior rectal resection(CRC-NOSESⅣtype)were selected as the study subjects.According to the different insertion methods of the anvil,63 cases were divided into the Hetao group and 40 cases into the purse-string forceps group.The operation time,placement time,intraoperative blood loss,postoperative recovery and complications were compared between the two groups.Results The placement time of anvil in the purse-string forceps group was(8.9±2.2)min,which was signifi cantly shorter than(13.9±2.3)min in the Hetao group(t=10.908,P<0.001).There were no significant differences between the two groups in terms of operation time,intraoperative blood loss,bed-off time after operation,time of exhaust after operation,or time of hospitalization after operation.The incidence of anastomotic leakage,intestinal obstruction,anastomotic bleeding,abdominal bleeding,intra-abdominal infection and total complications in the two groups were not statistically signifi cant.Conclusions Hetao method and purse-string forceps method have their own advantages and disadvantages,both of which are safe and reliable in laparoscopic high anterior rectal resection of CRC-NOSESⅣtype,with similar surgical complications and postoperative recovery.The two methods are worth trying and promoting.

关 键 词：经自然腔道取标本手术 乙状结肠癌 直肠癌 抵钉座 

分 类 号：R735.37[医药卫生—肿瘤]