腹腔镜直肠癌切除术单双吻合器行消化道重建的比较

Comparison of Single and Double Anastomat in the Digestive Tract Reconstruction for the Laparoscopic Resection of Rectal Cancer

目的比较腹腔镜下直肠癌切除术后单双吻合器行消化道重建的效果。方法 2012年8月~2015年1月选择在我院行择期腹腔镜直肠癌切除术患者78例,随机分为两组各39例,所有患者均行腹腔镜下直肠癌切除术,在消化道重建时分别采用单吻合器（单吻合器组）和双吻合器组（双吻合器）吻合,比较两组临床效果。结果所有患者均顺利完成手术,双吻合器组术后恢复进食半流质时间及术后住院时间都明显少于对照组（P〈0.05）,两组手术时间、术中出血量和术中输血量比较差异无统计学意义（P〉0.05）。术后3个月双吻合器组出现并发症4例,其中切口出血2例,吻合口瘘1例,吻合口梗阻1例;单吻合器组并发症18例,其中切口出血5例,切口感染3例,吻合瘘3例,吻合口梗阻4例,腹腔感染3例。双吻合器组术后并发症发生率明显少于单吻合器组（P〈0.05）。所有并发症经对症处理后均好转。双吻合器组术后3个月Hb与ALB值均较术前明显改善（P〈0.05）,且均显著高于对照组（P〈0.05）,而对照组手术前后Hb与ALB比较差异无统计学意义（P〉0.05）。结论双吻合器在腹腔镜下直肠癌切除术后消化道重建的应用有利于机体的恢复,从而促进患者的康复,减少术后并发症的发生。

Objective To compare the effect of single stapling and double stapling in the digestive tract reconstruction for laparoscopic rectal cancer resection. Methods From August 2012 to January 2015 in our hospital,a total of 78 patients with rectal cancer were enrolled the research and randomized into two groups with39 cases for each. After the laparoscopic rectal cancer,the digestive tract was reconstructed by single stapling in the single stapling group and by double stapling in the double stapling group. Results All patients were successfully completed surgery. Both postoperative recovery time of semi-liquid feeding and postoperative hospital stays were significantly shorter in double stapling group than that in single stapling group（ P 〈0. 05）,but there was no statistical difference in operative time,intraoperative blood loss and blood transfusion loss between two groups（ P〉 0. 05）. The postoperative complications were found in 4 cases of double stapling group,including 2 of incision bleeding,1 of anastomotic stoma fistula and 1 of anastomotic obstruction,and were found in18 cases of single stapling group,including 5 of incision bleeding,3 of wound infection,3 of anastomotic stoma fistula,4 of anastomotic obstruction and 3 of peritoneal infection. The postoperative complication rate of double stapling group was lower than that of single stapling group（ P〈 0. 05）. In the double stapling group,both levels of hemoglobin and albumin were remarkable higher in 3 months after the surgery than those of preoperation,and were obviously higher than those of the single stapling group（ P〈 0. 05）,but no statistical difference was found in both hemoglobin and albumin levels before and after the surgery in single stapling group（ P〉 0.05）. Conclusion The application of double stapling in the digestive tract reconstruction will benefit the nutritional status recovery,promote the rehabilitation and reduce the incidence of postoperative complications for rectal cases after laparoscopic rectal cancer.