“端-角”吻合在腹腔镜下直肠低位双吻合中的应用及效果观察

Laparoscopic ＂end-corner＂ anastomosis in double.stapling technique for mid-low rectal cancer resection

目的 观察一种改良直肠低位双吻合的临床效果,探讨其临床价值.方法 回顾性分析2011年2月至2015年2月在苏州大学附属第一医院完成腹腔镜下直肠低位前切除术的患者临床资料.根据直肠低位双吻合的操作方法不同,分为改良组（51例）和常规组（74例）,对比分析两组患者的一般资料、病理学检查结果、围手术期临床资料.应用SPSS 17.0进行统计学分析,计量资料采用￡检验,计数资料采用x2检验.结果 两组患者一般资料差异无统计学意义（P＞0.05）.改良组手术时间多于常规组[（169±23）比（150±42） min,t=-3.150,P＜0.05],而引流管留置天数[（7.9±2.9）比（10.8±11.6）d,t=1.999,P＜0.05]和术后住院天数[（10.0±3.6）d比（13.3±13.7）d,t=1.025,P＜0.05]短于常规组;改良组吻合口瘘的发生率（2.0％比18.9％,x2=4.402,P＜0.05）以及里急后重感的发生率（3.9％比17.6％,x2 =4.110,P＜0.05）低于常规组.两组患者术中出血量、排气时间、进食流质饮食时间、拔导尿管时间、吻合口出血、肠梗阻、再次手术造口以及术后感染差异无统计学意义.结论 与常规的腹腔镜下直肠低位前切除术相比,“端-角”吻合降低了术后吻合口瘘及“直肠低位前切除综合征”的发生率.

Objective To observe clinical efficacy and explore clinical value of a modified procedure of double-stapling technique for mid-low rectal cancer.Methods Clinical data of patients undergoing laparoscopic anterior resection at the Department of General Surgery,the First Affiliated Hospital of Soochow University from February 2011 to February 2015 was analyzed retrospectively.According to the different ways in doing double-stapling technique,we divided patients into modified group （51 cases） and conventional group （74 cases）.Parameters were compared between the two groups as general considerations,oncologic outcomes.Data were analyzed by SPSS 17.0 software packet,using t and x2 inspection.Results The difference of the general data of two groups was not statistically significant （P 〉 0.05）.Operation time in the modified group was longer than that of the conventional group [（169 ± 23） vs.（150 ±42）min,t =-3.150,P 〈0.05],but it had shorter drainage tube indwelling days [（7.9 ±2.9）d vs.（10.8±11.6）d,t=1.999,P〈0.05] and length of hospital stay after surgery [（10.0±3.6）d vs.（13.3 ± 13.7） d,t =1.025,P 〈 0.05].The incidence of anastomotic leakage （2.0% vs.18.9%,x2 =4.402,P 〈 0.05） and tenesmus（3.9% vs.17.6%,x2 =4.110,P 〈 0.05） in the modified group was less than that of the conventional group.The difference in those areas was not statistically significant （P 〉 0.05）,such as intraopretive blood loss,per-anal exhaust time,consumption of liquid diet time,anastomotic bleeding,intestinal obstruction,reoperation for neostomy and infections.Conclusions Compared with traditional laparoscopic anterior resection,＂End-Corner＂ anastomosis has the benefits of less postoperative anastomotic leakage and fewer＂ low anterior resection syndrome＂.