闭合钉切除在腹腔镜直肠癌根治术中防止吻合口漏的临床体会

Application of staples resection in preventing anastomotic fistula of laparoscopic radical operation for rectal cancer

目的:探讨闭合钉切除在腹腔镜直肠癌根治术中防止吻合口漏的可行性。方法:选取2016年1月至2018年4月收治的83例肿瘤下缘距肛缘大于7 cm的直肠癌(Ⅰ～Ⅲ期)患者作为研究对象,随机分为实验组(n=42)与对照组(n=41),两组均行腹腔镜直肠癌根治术,实验组采用类荷包缝合方式将远端直肠的闭合钉包埋入吻合器中切除从而实现肠管完全吻合,对照组采用传统吻合方式。结果:83例患者均顺利完成腹腔镜直肠癌根治术。实验组肠管吻合所需时间[(19.31±2.67) min vs.(10.17±2.44) min]长于对照组,差异有统计学意义(P <0.05);实验组术后排气时间[(3.14±1.07) d vs.(4.27±0.98) d]、住院时间[(10.60±2.08) d vs.(12.15±2.20) d]短于对照组,差异有统计学意义(P<0.05)。实验组未发生吻合口漏,发生其他并发症3例(7.14%),低于对照组[6例(14.63%)、10例(24.39%)],差异有统计学意义(P<0.05)。结论:严格把握手术适应证,腹腔镜直肠癌根治术中应用闭合钉切除技术是安全、可行的,可明显降低术后吻合口漏发生率,缩短住院时间。

Objective:To investigate the feasibility of staples resection in the prevention of anastomotic leakage in laparoscopic radical resection of rectal cancer.Methods:Eighty-three patients of rectal cancer(Ⅰ-Ⅲ),whose lower margins of the tumor were more than 7 cm,were selected as the research object from Jan.2016 to Apr.2018.They were randomly divided into the experimental group(n=42)or the control group(n=41).The two groups underwent laparoscopic radical resection of rectal cancer.In the experimental group,the distal rectal staples were embedded in the stapler by the type of pouch-like suture to achieve complete anastomosis of the intestine.The control group used the traditional anastomosis.Results:Eighty-three patients were successfully completed laparoscopic radical resection of rectal cancer.The time of intestine anastomosis in the experimental group was more than that in the control group[(19.31±2.67)min vs.(10.17±2.44)min,P<0.05].The exhaust time[(3.14±1.07)d vs.(4.27±0.98)d],the hospitalization time[(10.60±2.08)d vs.(12.15±2.20)d]in the experimental group were less than those in the control group,and the differences were statistically significant(P<0.05).There were 0 case of anastomotic leakage and 3 cases(7.14%)of other complications in the experimental group,which were lower than 6 cases(14.63%)and 10 cases(24.39%)in the control group,the differences were statistically significant(P<0.05).Conclusions:With strict indications of operation,it is safe and feasible to apply the technique of staples resection in the laparoscopic radical resection of rectal cancer,this procedure can obviously reduce the incidence of postoperative anastomotic leakage and the time of hospitalization.