带蒂大网膜骶前填塞预防直肠全系膜切除吻合口瘘的临床研究

Clinical research of the effect of pedicled greater omentum on the anastomotic fistula after total mesorectal excision of rectal carcinoma

目的:探讨带蒂大网膜骶前间隙填塞并包裹吻合口对直肠癌全系膜切除(Total mesorectal excision,TME)术后吻合口瘘的影响。方法:随机选择27例为研究组,按照TME要求完成直肠癌根治切除吻合后,裁剪大网膜下拉入盆腔填塞在骶前并包裹直肠吻合口。以同期21例未行大网膜填塞包裹病例为对照,观察直肠吻合口愈合情况。结果:本组病例无手术死亡。研究组无吻合口瘘发生,对照组吻合口瘘3例,P<0.05;研究组手术失血(343±176)ml,对照组(265±96)ml,P<0.05;研究组手术时间(146±47)min,对照组(129±36)min,P>0.05;术后肠蠕动恢复研究组(4.6±1.1)d,对照组(5.0±0.3)d,P>0.05,二者无显著意义。结论:术中采用带蒂大网膜骶前间隙填塞及吻合口包裹,可有效地预防直肠癌全系膜切除吻合口瘘的发生。

Objective：To approach the effect of pedicled greater omentum on the anastomotic fistula of total mesorectal excision in radical resection of rectal carcinoma. Methods：In research group,27 patients were randomly selected. After standard TME,their pedicled greater omentums were cut out to pack the presacral space and cover the stoma of rectum. In control group,21 patients without cover of greater omentum were randomly selected. The conditions of anastomotic stoma of all patients in both groups were observed. Results：Of patients in both groups,no death was found during the postoperative period. No anastomotic fistula was found in research group while 3 cases were found in control group （P〈0.05）. The average hemorrhage in research group was significantly increased when compared with control （343±176）ml vs（265±96）ml,P〈0.05）. But nosignificance in average time ofoperation（146±47）min vs（129±36）min,P〉0.05） or mean time before postoperative enterokinesia（4.6±1.1）day vs（5.0±0.3）day,P〈0.05）was observed between the research group and the control.Conclusion：Pedicled greater omentum efficaciously reduced the incidence rate of anastomotic fistula in TME of rectal carcinoma.