吻合口加强在腹腔镜中低位直肠癌根治术中的效果分析  

Effect analysis of anastomotic reinforce in laparoscopic radical resection of middle-low rectal cancer

作　　者：李亚芸 李上上 王梦龙 杨杰[1] 葛大强 谢宇 华胜和 LI Yayun;LI Shangshang;WANG Menglong(Department of General Surgery,Shuyang Traditional Chinese Medicine Hospital,Affiliated to Nanjing University of Chinese Medicine,Shuyang 223614,China)

机构地区：[1]南京中医药大学附属沭阳中医院普通外科,江苏沐阳223614

出　　处：《腹腔镜外科杂志》2023年第11期821-825,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜中低位直肠癌根治术中加强缝合的效果及术后短期并发症。方法:采用倾向性评分匹配法,对2014~2017年收治的498例中低位直肠癌患者进行匹配,将患者分为加强缝合组与未加强缝合组,比较两组患者的术中及术后近期指标。结果:经筛选后238例患者被匹配,每组119例,两组患者临床特征相似,加强缝合组手术时间长于未加强缝合组[(95.6±13.5)min vs.(84.3±15.2)min,P<0.001],造口患者比例(术中预防性造口:5.04%vs.16.81%,P=0.004;总造口率:5.88%vs.22.69%,P<0.001)、B/C级吻合口漏发生率(3.36%vs.11.76%,P=0.014)、吻合口出血发生率(3.36%vs.17.65%,P<0.001)低于未加强缝合组。两组术中失血量、肠功能恢复时间、术后住院时间差异无统计学意义。此外,男性、BMI≥24 kg/m^(2)、糖尿病、新辅助放化疗、距肛缘<5 cm是发生吻合口漏的独立危险因素。在高危患者中加强缝合可减少吻合口漏的发生(P=0.024),而在低危患者中差异无统计学意义(P=0.681)。结论:男性、肿瘤位置较低、BMI较高、糖尿病、接受新辅助放化疗的直肠癌患者吻合口漏发生率较高,吻合口加强缝合可减少全直肠系膜切除患者造口比例与术后短期并发症,尤其B/C级吻合口漏。Objective:To investigate the surgical outcomes and postoperative short-term complications of laparoscopic radical resection of middle-low rectal cancer with reinforcing sutures.Methods:Propensity score matching method was used for 498 cases of middle-low rectal cancer from^(2)014 to 2017.Patients were divided into reinforcing suture group and the group without reinforcing s utures.The intraoperative and postoperative short-term indicators were compared between the 2 groups.Results:After screening,238 patients were matched(119 cases in each group).The basic clinical characteristics were similar between the two groups.The operative time in the reinforcing suture group was(95.6±13.5)min,which was longer than(84.3±15.2)min in the group without reinforcing sutures(P<0.001).The percentage of patients with stomas was fewer in the reinforcing suture group compared with the group without reinforcing sutures(intraoperative preventive stomas:5.04%vs.16.81%,P=0.004;total rate of stomas:5.88%vs.22.69%,P<0.001),as well as the incidence of grade B/C anastomotic leakage(3.36%vs.11.76%,P=0.014)and anastomotic bleeding(3.36%vs.17.65%,P<0.001).There was no statistically significant difference between the two groups in intraoperative blood loss,bowel function recovery time,postoperative hospital stay.In addition,male,BMI≥24 kg/m^(2),diabetes mellitus,neoadjuvant radiochemotherapy,and distance to anal margin<5 cm were independent risk factors for anastomotic leakage.Reinforcing suture in high-risk p atients could reduce the incidence of anastomotic leakage(P=0.024),while no difference was found in patients with low risk(P=0.681).Conclusions:The incidence of anastomotic leakage is relatively higher in rectal cancer patients with following characteristics:male,low tumor location,high BMI,diabetes and neoadjuvant chemoradiotherapy.For patients with total mesorectal excision,anastomotic reinforcing suture can reduce colostomy proportion and postoperative short-term complications,especially grade B/C anastomotic leakage.

关 键 词：直肠肿瘤 吻合口漏 加强缝合 危险因素 倾向评分匹配 

分 类 号：R735.3[医药卫生—肿瘤]