腹腔镜经肛肠腔内检查技术预防直肠癌手术吻合口并发症的应用价值  

Application value of laparoscopic trans-anal intraluminal examination technology in preventing anastomotic complications of rectal cancer surgery

作　　者：蔡林弟 仇广林[1] 郑忠强 童颖目 徐佳 姚安亮 陈港心 郭雄 万华 廖新华[1] 车向明[1] 李徐奇[1] 樊林[1] CAI Lindi;QIU Guanglin;ZHENG Zhongqiang(Department of General Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院普通外科,陕西西安710061 [2]汉中市中医医院普通外科 [3]安康市人民医院普通外科 [4]榆林市榆阳区妇幼保健院普通外科 [5]安康市平利县医院普通外科

出　　处：《腹腔镜外科杂志》2025年第1期38-42,共5页Journal of Laparoscopic Surgery

基　　金：西安交通大学第一附属医院临床研究中心资助项目(XJTU1AF-CRF-2019-009)。

摘　　要：目的:探讨直肠癌前切除术肠管吻合后采用腹腔镜经肛肠腔内检查技术预防吻合口并发症的应用价值。方法:回顾分析2024年2月至2024年11月接受腹腔镜辅助直肠癌低位前切除术的73例患者的临床资料,其中35例术中采用腹腔镜经肛肠腔内吻合口检查(研究组),38例未检查吻合口(对照组),比较两组手术结局。结果:手术均顺利完成,两组患者基线资料、手术时间、术中出血量、术后首次排气时间、术后吻合口并发症、术后住院时间差异无统计学意义(P>0.05)。研究组术中经腹腔镜检查发现1例(2.9%)吻合口狭窄,经肛锐性分离后狭窄解除,术后无吻合口并发症发生。对照组中1例(2.6%)患者于术后第1天发生吻合口出血,1例(2.6%)于术后第3天出现吻合口漏,均经保守治疗后好转出院。结论:直肠癌术中采用腹腔镜经肛肠腔内检查吻合口具有高效确切、简便经济的优点,可作为术中肠镜检查的替代方法,以帮助早期发现吻合口异常并及时干预,值得进一步推广应用。Objective:To explore the application value of laparoscopic trans-anal intraluminal examination technique in preventing anastomotic complications after intestinal anastomosis in anterior resection of rectal cancer.Methods:A retrospective analysis was conducted on the clinical data of 73 patients who underwent laparoscopic-assisted low anterior resection for rectal cancer between Feb.2024 and Nov.2024.Among them,35 patients received laparoscopic trans-anal intraluminal anastomosis examination during surgery(study group),while 38 patients did not undergo anastomotic examination(control group).The surgical outcomes of the two groups were compared.Results:All surgeries were successfully completed without major complications.No statistically significant differences were observed between the two groups in terms of baseline characteristics,operative time,intraoperative blood loss,time to first postope-rative flatus,incidence of postoperative anastomotic complications,and postoperative hospital stay(P>0.05).In the study group,laparoscopic examination identified anastomotic stenosis in 1 patient(2.9%),which was successfully managed with trans-anal sharp dissection,and no postoperative anastomotic complications occurred.In the control group,1 patient(2.6%)experienced anastomotic bleeding on the first postoperative day,and another patient(2.6%)developed anastomotic leakage on the third postoperative day;both cases were managed conservatively,and all patients were discharged without further complications.Conclusions:The laparoscopic trans-anal intraluminal examination technique during rectal cancer surgery has the advantages of high efficiency,accuracy,simplicity,and cost-e ffectiveness.This technique serves as an effective alternative to intraoperative colonoscopy,enabling early detection of anastomotic abnormalities and timely intervention,thereby improving surgical safety.This approach warrants further clinical application and promotion.

关 键 词：直肠肿瘤 腹腔镜检查 吻合口并发症 

分 类 号：R735.37[医药卫生—肿瘤]