加固“狗耳朵区”降低腹腔镜直肠癌TME术后吻合口漏发生率的效果研究

Effect of reinforcing 'dog ear area' to reduce the risk of anastomotic leakage after laparoscopic TME for rectal cancer

目的探讨应用可吸收缝线加固"狗耳朵区"降低腹腔镜直肠癌全直肠系膜切除术(TME)术后吻合口漏发生率的临床效果。方法纳入2015年9月至2017年9月本院120例直肠癌患者作为研究对象,采用随机数字表法将患者分为观察组和对照组,每组各60例。两组均接受腹腔镜直肠癌TME术,观察组术中用可吸收缝线对"狗耳朵区"进行加固缝合。观察两组患者手术相关指标(手术时间、术中出血量、淋巴结清扫数目、术后首次肛门排气时间及术后住院时间),比较术后4 w内两组吻合口漏发生情况。结果两组患者手术时间、术中出血量及淋巴结清扫数目比较差异无统计学意义(P> 0.05),观察组术后首次肛门排气时间和术后住院时间均少于对照组,差异均有统计学意义(均P <0.05)。观察组术后吻合口漏发生率低于对照组,吻合口漏严重程度较对照组轻,差异均有统计学意义(均P <0.05)。结论腹腔镜直肠癌TME术中对"狗耳朵区"进行加固缝合有助于减少术后吻合口漏的发生。

Objectives To investigate reinforcing‘dog ear area’by using absorbable sutures to reduce risk of anastomotic leakage after laparoscopic total mesorectal excision(TME)for rectal cancer.Methods 120 patients with rectal cancer treated in our hospital between September 2015 and September 2017 were recruited as study subjects and were randomly assigned to treatment group and control group using random number table,with 60 patients in each group.Both groups received laparoscopic TME for rectal cancer.Patients in the treatment group received absorbable sutures to reinforce the‘dog ear area’.Indices related to surgery,including duration,amount of blood loss,number of dissected lymph nodes,time to first anal exhaust,and duration of hospitalization after surgery,as well as incidence of anastomotic leakage within four weeks of surgery,were compared between the two groups.Results There was no significant difference in duration of surgery,amount of blood loss,and number of dissected lymph nodes between the two groups(P>0.05).Time to first anal exhaust and duration of hospitalization were significantly shorter in the treatment group than in the control group(P<0.05).Incidence of anastomotic leakage was significantly lower and degree of leakage significantly less in the treatment group than in the control group(P<0.05).Conclusion Reinforcing‘dog ear area’by applying absorbable sutures during laparoscopic TME for recal cancer can reduce risk of postoperative anastomotic leakage.