超声刀联合双吻合器在开放直肠癌低位前切除术中的应用

Combined Application of Ultracision Harmonic Scalpel and Double Stapling Technique in Open Low Anterior Resection for Rectal Cancer

目的探讨超声刀联合双吻合器在开放直肠癌低位前切除术中的临床应用价值。方法 40例拟行直肠癌低位前切除的患者随机分为应用超声刀联合双吻合器20例作为研究组,应用高频电刀联合单吻合器20例作为对照组。比较2组的保肛成功率,同时观察保肛成功病例2组间手术时间、术中出血量、术后第1个24h引流量、术后并发症、肠功能恢复时间及住院时间的差异。结果研究组保肛成功19例(95%),对照组保肛成功14例(70%),2组相比P=0.037;33例保肛成功患者中,研究组手术时间(102.5±14.6m)较对照组(114.7±17.5m)明显缩短(P=0.032);研究组手术出血量(62.5±19.3)mL较对照组(91.3±26.5)mL显著减少(P=0.001);术后第1个24h引流量研究组和对照组分别为(33.6±15.0)mL、(65.7±25.9)mL(P<0.001);术后首次排气时间分别为(2.4±0.6)d、(2.9±0.4)d(P=0.004);术后平均住院天数研究组较对照组也显著缩短(P=0.014);2组术后并发症无显著差异(P=0.674)。结论开放直肠癌低位前切除术中应用超声刀联合双吻合器是直肠癌手术向微创手术理念和快速康复外科理念发展的尝试,在开放直肠癌手术领域具有广泛的应用前景。

Objective To investigate the clinical value of ultracisian harmonic scalpel associating double stapling technique in open low anterior resection for rectal cancer. Methods Forty selected rectal cancer patients planed to perform low anterior resection were randomized into two groups in which 20 cases by ultracision harmonic scalpel associating double stapling technique（study group） while the others by high frequency electrome associating single stapler as control group. Ano-saving rate was compared between the two groups. Other indexes including sphincter preserving rate,operating time,blood loss during operation, volume of drain at first 2411 after operation, time of funCtional recovery of intestinal tract,incidence of complications and hospital stay were compared, respectively. Results Significant difference was observed between the two groups in the Ano--saving rate （P^0.037） but not seen in incidence of overall complications （P=0.674）. In 33 eases in which LAR were done ,there were significant differences between the study group and the control group in the operating time（P=0.032）, blood loss during operation （P=0.001）, volume of drain at first 24h after operation （P〈0.001）,the time of functional recovery of intestinal tract（P=0.004）and the hospital stay（P=0.014）,respectively. Conclusion Combined application of ultracision harmonic scalpel and double stapling technique in open low anterior resection for rectal cancer is an attempt of minimally invasive operation and fast-track surgery for for rectal cancer and will be widely applied in open operation.