三种方式关闭盆底联合改良造口在直肠癌腹会阴联合切除术的对比研究  

Comparative study of three methods of pelvic floor closure combined with improved ostomy in combinedabdominoperineal resection of rectal cancer

作　　者：嵇晋 吴胜文[1] 姜明瑞 汪刘华[3] 王伟[3] 任俊[3] 王道荣[3] 马从超 Ji Jin;Wu Shengwen;Jiang Mingrui;Wang Liuhua;Wang Wei;Ren Jun;Wang Daorong;Ma Congchao(Department of Gastrointestinal Surgery,Jianhu County People's Hospital,Jianhu Jiangsu Province 224700,China;Medical College of Yangzhou University,Yangzhou Jiangsu Province 225001,China;Department of Gastrointestinal Surgery,Northern Jiangsu People's Hospital,Yangzhou Jiangsu Province 225001,China)

机构地区：[1]建湖县人民医院胃肠外科,江苏建湖224700 [2]扬州大学医学院,江苏扬州225001 [3]江苏省苏北人民医院胃肠外科,江苏扬州225001

出　　处：《中华普外科手术学杂志（电子版）》2024年第4期406-410,共5页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：江苏省扬州市科技计划项目(YZ2020159)。

摘　　要：目的探讨不同手术方式关闭盆底腹膜联合改良造口在低位直肠癌腹会阴联合切除术的应用效果。方法回顾性分析2020年1月至2022年11月58例实施腹会阴联合切除术的低位直肠癌患者临床资料,按手术方式不同分为机器人腹会阴联合切除术(RAPR)组17例、腹腔镜腹会阴联合切除术(LAPR)组26例和传统腹会阴联合切除术(APR)组15例。数据采用SPSS25.0软件分析,围手术期指标及术后病理结果等计量资料以(x±s)表示,采用单因素方差分析;术后植物神经功能和并发症比较,采用X检验或Fisher精确分析。P<0.05表示差异有统计学意义。结果果RAPR组较LARP组和APR组手术时间长、淋巴结清扫数目多;RAPR组和LAPR组较APR组术中出血量少、拔除尿管时间早、术后住院时间短、术后会阴部感染率及会阴切口裂开率低、术后排尿功能以及保护男性性功能好,差异有统计学意义(P<0.05);三组患者在术后首次排气时间、术后首次排便时间、造口相关并发症及其他会阴部并发症比较,差异无统计学意义(P>0.05)。结论运用达芬奇机器人和腹腔镜进行盆底腹膜关闭联合改良造口在低位直肠癌腹会阴联合切除术中是安全可行的,具有一定的应用价值。Objective To investigate the effect of different surgical methods of closing pelvic floor peritoneum combined with improved ostomy in combined abdominoperineal resection of low rectal cancer.MethodsThe clinical data of 58 patients with low rectal cancer who underwent combined abdominoperineal resection from January 2020 to November 2022 were retrospectively analyzed,and they were divided into robot combined abdominoperineal resection(RAPR)group(17 cases),laparoscopic combined abdominoperineal resection(LAPR)group(26 cases),and traditional combined abdominoperineal resection(APR)group(15 cases)according to different surgical methods.SPSS 25.O software was used to analyze the data.Measurement data such as perioperative indicators and postoperative pathological results were expressed as(x±s)and One-way ANOVA of variance was used.The autonomic nerve function and complications were compared by Chi-square test or Fisher analysis.P<0.05 indicated that the difference was statistically significant.Results Compared with LARP group and APR group,RAPR group had longer operation time and more lymph node dissection.Compared with APR group,RAPR group and LAPR group had less intraoperative blood loss,earlier urinary tube removal time,shorter postoperative hospital stay,lower perineal infection rate and perineal incision dehision rate,better postoperative urination function and protective male sexual function,with statistical significance(P<0.05).There was no significant difference in the first postoperative exhaust time,first postoperative defecation time,stomato-related complications and other perineal complications among the three groups(P>0.05).Conclusion The use of Da Vinci robot and laparoscope for pelvic floor peritoneal closure combined with improved ostomy is safe and feasible in the combined abdominoperineal resection of low rectal cancer,and has certain application value.

关 键 词：直肠肿瘤 机器人手术 腹腔镜 腹膜 造口术 

分 类 号：R735.37[医药卫生—肿瘤]