腹腔镜直肠癌保肛手术术后吻合口漏与钉仓数量关系的研究

Study on the Relationship between Anastomotic Leakage and the Number of Staple Cartridge after Laparoscopic Rectal Cancer Anus-preserving Operation

目的本研究旨在探讨腹腔镜直肠癌保肛手术术中钉仓使用数量与术后吻合口漏之间的关系,以期尽量降低吻合口漏的发生。方法回顾性分析2013年1月1日～2017年1月1日4年间西南医科大学附属医院胃肠外科行腹腔镜直肠癌保肛手术的205例患者的临床资料,总结患者性别、年龄、体重指数(BMI)、肿瘤下缘距齿状线距离、肿瘤直径、术中出血量、手术时间、术后肛门排气时间等一般情况,分析患者钉仓使用数量与术后吻合口漏之间的关系。结果术中使用1枚钉仓的患者为42例,术后有1例发生吻合口漏;术中使用2枚钉仓的患者为140例,术后有8例发生吻合口漏;术中使用3枚钉仓的患者为23例,术后有6例发生吻合口漏(χ~2=10. 087,P=0. 004),差异有统计学意义。结论在腹腔镜直肠癌保肛手术中,钉仓使用数量越多,切缘的交界也就越多,切缘与直肠纵轴之间的角度越大,残余直肠的血供就越差,术后发生吻合口漏的风险越大。

Objective To investigate the relationship between the number of staple cartridges used in intraoperative tumor distal margin and postoperative anastomotic leakage,so as to minimize the incidence of anastomotic leakage.Methods Between January 1,2013 and January 1,2017,a retrospective analysis of 205 cases of laparoscopic anus-preserving rectal cancer resection was performed in gastrointestinal surgery,the Affiliated Hospital of Southwest Medical University.The date of gender,age,body mass index(BMI),the distance between the lower margin of the tumor and the dentate line,tumor diameter,intraoperative bleeding,operation time,time of anus exhaust defecation and were recorded,the relationship between the number of staple cartridge and postoperative anastomotic leakage was analyzed.Results 42 patients used 1 staple cartridge intraoperation and postoperative anastomotic leakage occurred in 1 patient.140 patients used 2 staple cartridges intraoperation and postoperative anastomotic leakage occurred in 8 patients.23 patients used 3 staple cartridges intraoperation and postoperative anastomotic leakage occurred in 6 patients(χ2=10.087,P=0.004).The differences were statistically significant.Conclusion In the operation laparoscopic rectal cancer anus-preserving,the more staple cartridges used,and there have more border of incisal margin,the blood supply to the residual rectum become more worse,the more likely it was for anastomotic leakage to occur.