中低位直肠癌术中经肛门腔镜下加固缝合吻合口单中心研究  

A single-center study of transanal endoscopic reinforcement of the anastomosis in middle and low rectal cancer surgery

作　　者：孟聪 李杨[1] 石晋瑶 孙丽婷 魏鹏宇 宋建宁[1] 吴国聪[1] 姚宏伟[1] 张忠涛[1] MENG Cong;LI Yang;SHI Jin-yao(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,National Key Laboratory for Digestive Health,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、消化健康全国重点实验室、首都医科大学结直肠肿瘤临床诊疗及研究中心,北京100050

出　　处：《中国实用外科杂志》2023年第10期1147-1151,共5页Chinese Journal of Practical Surgery

基　　金：北京市临床重点专科基金项目(No.2018-118);国家重点研发计划资助项目(No.2017YFC0110904);首都医科大学附属北京友谊医院科研启动基金项目(No.YYQDKT20165)。

摘　　要：目的探讨中低位直肠癌术中经肛门腔镜下检查及加固缝合吻合口的安全性和有效性。方法回顾性分析2022年1—12月首都医科大学附属北京友谊医院普通外科收治的行手术治疗的43例中低位直肠癌病人的临床资料,术中均经肛门腔镜下加固缝合吻合口。主要观察指标为吻合口漏发生率和预防性造口比例。结果43例病人均顺利完成保肛手术并经肛门腔镜下加固缝合吻合口,包括27例经肛全直肠系膜切除(taTME)手术和16例腹腔镜全直肠系膜切除(TME)手术,无中转开放手术病例。12例(27.9%)病人行端端吻合。20例(46.5%)行预防性回肠造口。经肛门腔镜下观察吻合口发现,37例(86.0%)病人吻合口有渗血,21例(48.8%)病人见外露的吻合钉。经肛门腔镜下加固缝合时间为(10.5±2.0)min。中位住院时间为11(8~29)d。术后30 d内并发症发生率为18.6%(8/43)。吻合口漏的发生率为6.9%(3/43),其中A级1例,B级2例。发生吻合口漏的3例中病人术前均行新辅助放化疗。无再次手术病例。术后无病人出现吻合口狭窄。术后发生盆腔出血1例(2.3%),盆腔感染1例(2.3%),不全性肠梗阻2例(4.6%)。结论中低位直肠癌手术中经肛门腔镜下检查和加固缝合吻合口后可减少吻合口漏的发生,对于预防高危病人吻合口相关并发症具有临床价值。Objective To explore the new technology of using transanal endoscopic inspection and reinforcement suturing anastomosis in middle and low rectal cancer surgery,and evaluate its safety and effectiveness.Methods A descriptive research method was used to retrospectively collect the clinical data of 43 patients who underwent transanal laparoscopic reinforcement of anastomotic stoma during TME or taTME surgery for rectal cancer from January 2022 to December 2022.The primary outcome measures were the incidence of anastomotic leakage and the rate of preventive stoma.Results All 43 patients completed the anus-preserving operation,and the anastomosis was reinforced and sutured through the anus laparoscope,including 27 cases of taTME surgery and 16 cases of laparoscopic TME surgery,and none of them were converted to laparotomy.12 cases(27.9%)underwent end-to-end anastomosis,and 20 cases(46.5%)underwent prophylactic ileostomy.According to the observation of an anastomotic stoma under an anal endoscope,37 patients(86.0%)had blood leakage at the anastomotic stoma;Exposed staples were seen in 21 patients(48.8%).The average time for reinforcement suture under an anoscope was 10.5±2.0 min.The median hospital stay was 11(8-29)days.The overall incidence of postoperative complications within 30 days after surgery was 23.3%.The incidence of AL was 6.9%,including 1 case of grade A and 2 cases of grade B.Among the 3 cases with anastomotic leakage,all patients received neoadjuvant radiotherapy and chemotherapy before the operation,and no patients underwent reoperation.No patient had anastomotic stenosis after the operation.There was 1 case of pelvic bleeding(2.3%),2 cases of anastomotic bleeding(4.6%),1 case of pelvic infection(2.3%),and 2 cases of incomplete intestinal obstruction(4.6%).Conclusion The incidence of anastomotic leakage is lower after transanal endoscopic inspection and reinforcement suturing anastomosis during rectal cancer surgery,which is more clinically meaningful for high-risk patients to prevent anastomotic-relate

关 键 词：全直肠系膜切除 经肛全直肠系膜切除 吻合口漏 经肛 腔镜 加固缝合 

分 类 号：R6[医药卫生—外科学]