达芬奇机器人低位直肠癌保肛手术中支架法回肠转流术预防吻合口漏的临床分析  

Clinical analysis of a novel stent assisted ileal bypass for preventing anastomotic leakage in Da Vinci robot anus-preserving surgery of low rectal cancer

作　　者：严嘉宁 殷永芳 杨佳宾 严志龙 谢建明 Yan Jianing;Yin Yongfang;Yang Jiabin;Yan Zhilong;Xie Jianming(Department of General Surgery,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310016,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital of NingboUniversity,Ningbo315000,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院普外科,杭州310016 [2]宁波大学附属第一医院胃肠外科,宁波315000

出　　处：《中华普通外科杂志》2025年第2期114-118,共5页Chinese Journal of General Surgery

基　　金：浙江省医药卫生科技计划项目(2020KY813)。

摘　　要：目的探讨达芬奇机器人低位直肠癌保肛手术中采用支架法回肠转流术预防吻合口漏的安全性和有效性。方法回顾性分析2021年12月至2024年9月于宁波大学附属第一医院接受机器人低位直肠癌保肛手术+支架法回肠转流术的55例患者的临床资料。结果55例患者均顺利完成手术,其中47例患者经低位前切除术,8例患者经括约肌间切除术。平均手术时间(207±37)min,其中回肠转流平均手术时间(24±3)min,术中平均出血量(32±18)ml。术后平均转流支架崩解时间(23.93±2.87)d,术后平均拔除转流管时间(29.55±3.21)d。术后TNM分期中,T1期12例,T2期26例,T3期17例;淋巴结清扫数目(16.84+4.50)个,淋巴结转移阳性15例,阴性40例;Ⅰ期36例,Ⅱ期4例,Ⅲ期15例。中位随访时间20(2~35)个月。1例患者发生延迟性吻合口漏,2例患者出现吻合口狭窄。结论达芬奇机器人低位直肠癌保肛手术中支架法回肠转流术预防吻合口漏是安全有效的。Objective:To explore the safety and effectiveness of ileal bypass with stent to prevent anastomotic leakage in Da Vinci robot anus-preserving surgery for low rectal cancer.Methods:From Dec 2021 to Sep 2024,the clinical data of 55 patients undergoing robot anus-preserving surgery and stent ileal bypass for low rectal cancer in the First Affiliated Hospital of Ningbo University was analyzed retrospectively.Results:All the 55 patients successfully completed the operation.Among them,47 patients underwent low anterior resection and 8 patients did sphincter resection.The total operation time was(207±37)min,the operation time of ileal bypass was(24±3)min,and the intraoperative blood loss was(32±18)ml.After operation,the time of stent disintegration was(23.93±2.87)days,and the time of catheter removal was(29.55±3.21)days.By postoperative TNM staging,there were 12 cases in T1 stage,26 cases in T2 and 17 cases in T3.The number of lymph node dissection was(16.84±4.50),15 cases being positive for lymph node metastasis,40 cases being negtive for lymph node metastasis,36 cases were stageⅠ,4 cases were stageⅡand 15 cases were stageⅢ.The median follow-up time was 20(2-35)months.Delayed anastomotic leakage occurred in 1 patient and anastomotic stenosis occurred in 2 patients.Conclusion:Stent ileal bypass is safe and effective to prevent anastomotic leakage in Da Vinci robot anus-preserving surgery for low rectal cancer.

关 键 词：直肠肿瘤 支架 吻合口漏 机器人 

分 类 号：R735.37[医药卫生—肿瘤]