腹腔镜对比开放手术腹膜外造口联合盆底腹膜重建在直肠癌APR手术中的应用

Laparoscopic versus open surgery for closing the pelvic floor peritoneum combined with extraperitoneal stoma in rectal cancer

目的探讨腹腔镜和开放两种不同的手术方式应用腹膜外造口联合盆底腹膜重建在低位直肠癌腹会阴联合切除手术中的效果.方法回顾性分析2016年01月-2021年12月在江苏省苏北人民医院胃肠中心实施腹会阴联合切除手术的低位直肠癌患者的临床资料,按手术方式不同分为腹腔镜腹会阴联合切除术(laparoscopic abdominoperineal resection,LAPR)组(腹腔镜手术59例)和腹会阴联合切除术(abdominoperineal resection,APR)组(开放手术63例),比较一般资料、围术期资料、术后病理、造口并发症、会阴部并发症.结果两组患者在引流管拔除时间、首次排气时间、首次排便时间、造口并发症、会阴疝、粘连性肠梗阻、盆底腹膜疝比较无统计学差异(P>0.05),LAPR组较APR组手术时间短、术中出血量少、术后住院时间短、清扫淋巴结数目多、拔除尿管时间早、患者夜尿次数少、会阴切口感染少、切口裂开少,差异具有统计学差异(P<0.05).结论运用腹腔镜进行腹膜外造口联合盆底腹膜重建是安全可行的,可减少手术时间和术中出血、缩短术后住院时间、提高淋巴结清扫数目、更好地保护盆腔植物神经,降低部分会阴并发症发生率,在临床中具有一定的实用价值.

Objective To investigate the effect of applying extraperitoneal stoma combined with pelvic floor peritoneal reconstruction in APR surgery for low rectal cancer by two different surgical approaches,laparoscopic and open surgeries.Methods Through retrospective analysis of clinical data,patients with low rectal cancer who underwent APR surgery at the Gastrointestinal Center of Jiangsu Subei People's Hospital from January 2016 to December 2021 were divided into LAPR group(59 cases of laparoscopic surgery)and APR group(63 cases of open surgery)according to different surgical methods.General data,perioperative data,postoperative pathology,stoma complications and perineal complications were compared.Results There were no statistical differences(P>0.05)between the two groups in the time to drainage tube removal,time to first venting,time to first defecation,stoma complications,perineal hernia,adhesive bowel obstruction,and pelvic floor peritoneal hernia.The LAPR group had shorter operative time,less intraoperative bleeding,shorter postoperative hospital stay,greater number of lymph nodes cleared,earlier removal of urinary catheter,less frequent nocturnal urination of patients,less perineal incision infection,and the differences were statistically different(P<0.05).Conclusion The use of laparoscopy for extraperitoneal stoma combined with pelvic floor peritoneal reconstruction is safe and feasible,which can reduce operative time and intraoperative bleeding,shorten postoperative hospital stay,improve the number of lymph node dissection,better protect the pelvic vegetative nerves,and reduce the incidence of some perineal complications,thus has certain practical value in clinical practice.