PE-Bacon术治疗慢性放射性直肠损伤晚期并发症的安全性和有效性分析  

Safety and effectiveness analysis of proximal extended excision Bacon(PE-Bacon)in the treatment of late complications of radiation-induced rectal injury

作　　者：林子鸿 黄斌杰[2] 甄潮辉 秦启元 罗杰龙 杨志勇 修风民 梁锐 马腾辉[2] Lin Zihong;Huang Binjie;Zhen Chaohui;Qin Qiyuan;Luo Jielong;Yang Zhiyong;Xiu Fengmin;Liang Rui;Ma Tenghui(Department of Gastrointestinal Surgery,Dongguan First Hospital Affiliated to Guangdong Medical University,Dongguan 523000,Guangdong,China;Department of General Surgery(Division of Colorectal Surgery,Radiation Intestinal Injury Center),The Sixth Affiliated Hospital of Sun Yat-sen University/Guangdong Key Laboratory for Colorectal and Pelvic Floor Diseases/Huangpu District Bio-medical Innovation Research Institute,Guangzhou 510655,Guangdong,China)

机构地区：[1]广东医科大学附属东莞第一医院胃肠外科,广东东莞523000 [2]中山大学附属第六医院普通外科(结直肠外科、放射性肠损伤中心)/广东省结直肠盆底疾病研究重点实验室/广州市黄埔区中六生物医学创新研究院,广东广州510655

出　　处：《结直肠肛门外科》2025年第1期16-21,共6页Journal of Colorectal & Anal Surgery

基　　金：中山大学附属第六医院临床医学研究1010计划项目(1010CG〔2022〕-09);广东省医学科研基金项目(A2024591)。

摘　　要：目的探讨腹腔镜直肠乙状结肠扩大切除结肠拖出术治疗慢性放射性直肠损伤晚期并发症的安全性和有效性。方法回顾性分析中山大学附属第六医院、广东医科大学附属东莞第一医院2012年9月至2024年10月期间因慢性放射性直肠损伤晚期并发症行腹腔镜直肠乙状结肠扩大切除结肠拖出术的158例患者临床及随访资料。统计并分析患者的手术相关指标(手术方式、手术时间、术中出血量、术中输血情况)、术后并发症情况、造口回纳及造口回纳后排粪功能情况。结果158例患者中,148例行腹腔镜手术,9例行开腹手术,1例中转开腹,其中58例联合经肛腔镜手术。中位手术时间为276(229,337)min,中位出血量为100(50,100)mL,26例患者术中输血。术后30 d内发生Ⅲb级及以上严重并发症13例,其中Ⅲb级并发症9例,Ⅳ级并发症4例。术后有20例患者因并发症需再入院治疗。全组患者术后1年慢性放射性直肠损伤症状明显缓解或消失,有75例实现造口回纳,造口回纳率为51%(75/147)(有11例患者未达造口回纳时间,即术后3个月及以上),平均造口回纳与手术间隔时间为(329.2±188.3)d。造口回纳后,8例无低位前切除综合征,12例发生轻度低位前切除综合征,46例发生重度低位前切除综合征,9例死亡或失访。此外,造口回纳后有7例患者因并发症需再造口。结论腹腔镜直肠乙状结肠扩大切除结肠拖出术治疗慢性放射性直肠损伤晚期并发症安全可行,术后并发症发生率低,但需采取措施预防可能导致的重度低位前切除综合征。Objectives To explore the safety and effectiveness of PE-Bacon for late complications of radiation-induced late rectal injury(RLRI).Methods A retrospective analysis was conducted on the clinical and follow-up data of 158 patients who underwent PE-Bacon for late complications of RLRI at the Sixth Affiliated Hospital of Sun Yat-sen University and Dongguan First Hospital Affiliated to Guangdong Medical University from September 2012 to October 2024.Surgical indicators(surgical approach,operative time,intraoperative blood loss,intraoperative blood transfusion),postoperative complications,stoma reversal,and defecation function after stoma reversal were collected and analyzed.Results Among the 158 patients,148 underwent laparoscopic surgery,9 underwent open surgery,and 1 was converted to open surgery,and 58 of them were combined with transanal endoscopic microsurgery.The median operative time was 276(229,337)minutes,the median blood loss was 100(50,100)mL,and 26 patients required intraoperative blood transfusion.Within 30 days postoperatively,13 patients experienced severe complications of gradeⅢb or higher,including 9 gradeⅢb and 4 gradeⅣcomplications.Twenty patients required rehospitalization due to complications.One year postoperatively,symptoms of RLRI significantly improved or resolved in all patients.Stoma reversal was achieved in 75 patients,with a reversal rate of 51%(75/147)(11 patients did not reach the stoma reversal time point,i.e.,3 months or more postoperatively),and the average interval between stoma reversal and the initial surgery was(329.2±188.3)days.After stoma reversal,8 patients had no low anterior resection syndrome(LARS),12 had mild LARS,46 had severe LARS,and 9 died or were lost to follow-up.Additionally,7 patients required restoma creation due to complications after stoma reversal.Conclusion PE-Bacon is safe and feasible for the treatment of late complications of RLRI,with a low incidence of postoperative complications.However,measures should be taken to prevent possible severe LARS.

关 键 词：慢性放射性直肠损伤 晚期并发症 腹腔镜直肠乙状结肠扩大切除结肠拖出术 肛门成形术 

分 类 号：R619.9[医药卫生—外科学]