倒刺缝线关闭盆底腹膜联合骶前双套管负压冲洗引流在腹腔镜直肠前切除中的应用

Pelvic peritoneum reconstuction with barbed suture combined with irrigation and negative pressure drainage in laparoscopic rectal anterior resection for rectal cancer

目的探讨倒刺缝线关闭盆底腹膜联合骶前双套管负压冲洗引流在腹腔镜直肠前切除中的效果。方法回顾性分析2014年5月至2018年5月南阳市中心医院收治的159例局部进展期直肠癌患者的临床资料,其中倒刺缝线关闭盆底腹膜联合骶前双套管负压冲洗引流组为研究组(76例)和不关闭盆底腹膜组为对照组(83例)。结果两组手术时间相比差异无统计学意义[(165±18)min比(160±17)min,t=0.098,P=0.069]。与对照组相比,研究组术后引流管放置时间[(5.7±2.4)d比(7.4±3.7)d,t=3.309,P=0.001]、术后腹腔感染发生率(7%比17%,x^2=3.991,P=0.046)及吻合口漏发生率(4%比13%,x^2=4.280,P=0.039)相比差异均有统计学意义。两组术后吻合口狭窄和肠梗阻发生率相比差异无统计学意义(15%比10%,x^2=1.088,P=0.297;9%比11%,x^2=0.117,P=0.732)。结论倒刺缝线关闭盆底腹膜简单易行、安全可靠,联合骶前双套管负压冲洗引流可缩短引流管放置时间,降低发生腹腔感染和吻合口漏的风险。

Objective To evaluate pelvic peritoneum reconstruction with barbed suture and irrigation and negative pressure drainage in laparoscopy rectal anterior resection for locally advanced rectal cancer.Methods From 2014 to 2018 159locally advanced rectal cancer patients treated by laparoscopy were derided into study group (n=76),and those received gravity drainage without pelvic peritoneum reconstruction (n =83).Results There were not significant difference in the operation time between the two groups [(165±18)rain vs.(160±17)min,t =0.098,P =0.069].There were significant differences in postoperative drainage tube indwelling duration [(5.7±2.4)d vs.(7.4±3.7)d,t =3.309,P = 0.001],intraabdominal infection (7% vs.17%,x^2=3.991,P =0.046)and anastomotic leakage (4% vs.13%,x^2=4.280,P =0.039).There was no significant difference in anastomotic stenosis (5% vs. 10%,x^2=1.088,P =0.297)and intestinal obstruction (9% vs.11%,x^2=0.117,P =0.732)between the two groups.Conclusion It is simple,safe and reliable to perform pelvic peritoneal reconstruction using barbed suture,combined with irrigation and negative pressure drainage,it can decrease drainage tube indwelling duration,reduce the incidence of intraabdominal infection and anastomotic leakage.