腹腔镜中低位直肠癌根治术经肛吻合口加固预防吻合口瘘

Transanal anastomotic reinforcement on anastomotic leakage after laparoscopic radical resection for middle and low rectal cancer

目的:探讨腹腔镜中低位直肠癌根治术(Dixon)经肛加固吻合口对预防直肠癌术后吻合口瘘的可行性。方法:收集2019年08月至2022年05月我院普外科行腹腔镜中低位直肠癌根治手术(Dixon)患者共127例。根据指南,中低位直肠癌为肿瘤下缘距离肛门10 cm以内,根据吻合口加固方式不同分为三组:经肛连续缝合组(n=43);经肛间断缝合组(n=42);对照组(未经肛门缝合组)(n=42)。对患者一般资料、手术时间、术中出血量、肛门首次排气时间、进流食时间、术后住院时间、吻合口瘘、吻合口出血、切口感染、肛周疼痛进行比较。结果:三组患者一般资料比较无统计学差异(P>0.05),与对照组比较,经肛连续缝合组和经肛间断缝合组在手术时间、术中出血量、进流食时间、术后肛门排气时间、切口感染、肛周疼痛无统计学差异(P>0.05),而吻合口瘘方面,连续缝合组为4.65%,间断缝合组为4.76%,对照组为16.67%,三组间比较虽无统计学差异(P=0.079),但提示经肛缝合可降低吻合口瘘的发病,术后住院时间,间断缝合组为(8.17±1.52)d,连续缝合组为(8.15±1.69)d,对照组为(12.13±1.57)d,有统计学差异(P=0.035),经肛连续缝合组和经肛间断缝合组间比较术后住院时间无统计学差异(P>0.05)。C级吻合口瘘对照组例数为3例,多于经肛缝合组1例。结论:腹腔镜中低位直肠癌根治手术经肛连续吻合口加固和经肛间断吻合口加固能降低术后吻合口瘘,技术操作简单,并缩短住院时间,可以临床推广应用。

Objective:To explore the feasibility of transanal reinforcement of anastomosis in laparoscopic radical resection of middle and low rectal cancer(Dixon)to prevent anastomotic leakage.Methods:From August 2019 to May 2022,127 patients with Dixon who underwent laparoscopic radical resection of middle and low rectal cancer were collected.According to the guidelines,the middle and lower rectal cancer was within the distance of the lower margin of the tumor from the anal 10 cm.The middle and low rectal cancer were divided into three groups according to the different ways of strengthening the anastomosis:Continuous transanal suture group(n=43),intermittent transanal suture group(n=42)and control group(n=42).The general data,operation time,intraoperative blood loss,first anal exhaust time,feeding time,postoperative hospital stay,anastomotic leakage,anastomotic bleeding,incision infection and perianal pain were compared.Results:There was no significant difference in general data among the three groups(P>0.05).Compared with the control group,there was no significant difference in operation time,intraoperative blood loss,feeding time,postoperative anal exhaust time,incision infection and perianal pain between the continuous suture group and the intermittent suture group(P>0.05).The anastomotic leakage was 4.65% in the continuous suture group and 4.76%in the intermittent suture group,and 16.67% in the control group.Although there was no significant difference among the three groups,it was suggested that transanal suture could reduce the incidence of anastomotic leakage.The postoperative hospital stay was(8.17±1.52)days in the intermittent suture group,(8.15±1.69)days in the continuous suture group and(12.13±1.57)days in the control group(P<0.05).There was no significant difference in postoperative hospital stay between the continuous transanal suture group and the transanal intermittent suture group(P>0.05).The number of grade C anastomotic leakage in the control group(3 cases)was higher than that in the transanal suture group(1 case).Conclusion:Laparoscopic middle and low rectal cancer radical surgery transanal continuous anastomosis reinforcement and transanal intermittent anastomosis reinforcement can reduce postoperative anastomotic leakage,simple technical operation,and shorten hospital stay,which can be widely used in clinic.