腹腔镜与开腹二次手术治疗腹腔镜结直肠癌术后吻合口漏的疗效比较

Comparison of laparoscopic versus open re-surgery for treatment of postoperative anastomotic leakage after laparoscopic colorectal surgery

目的探讨采用腹腔镜与开腹二次手术治疗腹腔镜结直肠癌术后吻合口漏的安全性与可行性。方法采用回顾性病例对照研究的方法,分析2013年3月至2018年10月因腹腔镜结直肠癌术后吻合口漏在中国医学科学院肿瘤医院结直肠外科进行非计划二次手术的55例患者的临床资料,根据二次手术的方式将患者分为开腹组(41例)与腹腔镜组(14例),统计分析两组患者的基本信息、初次手术数据、二次手术数据,比较两种治疗方式的近期效果。结果两组患者的基本信息及初次手术数据比较差异均无显著性(P>0.05)。腹腔镜组的出血量为15.0(10.0,20.0)ml,明显少于开腹组的25.0(20.0,50.0)ml,差异有显著性(P<0.05)。腹腔镜组术后首次排气时间为2.5(1.8,3.0)d,明显短于开腹组的3.0(2.0,6.0)d,差异有显著性(P<0.05)。腹腔镜组的总住院天数、二次手术后住院天数分别为23.5(16.5,34.0)d、6.5(4.8,13.8)d,明显少于开腹组的29.0(24.5,35.5)d、11.5(8.0,16.8)d,差异均有显著性(P<0.05)。结论腹腔镜二次手术治疗结直肠癌术后吻合口漏安全可行,与传统开腹手术相比具有较好的近期结局。

Objective To investigate and evaluate the safety and feasibility of laparoscopic versus open re-surgery for treatment of anastomotic leakage after laparoscopic colorectal cancer. Method A retrospective case-control study was conducted to analyze clinical data of 55 patients who underwent the unplanned re-surgery for anastomotic leakage after initial laparoscopic colorectal surgery in the Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from March 2013 to October 2018. Patients were divided into open re-surgery group(n=41) and laparoscopic re-surgery group(n=14) according to the operation method. The basic information, first operation related data, re-operation related data and outcomes of re-surgery were analyzed to compare the short-term therapeutic effect. Result There were no statistically differences in the basic information and first operation related data between the two groups(all P>0.05). The amount of bleeding in re-operation in the laparoscopic re-surgery group was significantly less than the open re-surgery group [15.0(10.0, 20.0) ml vs. 25.0(20.0, 50.0) ml, P<0.05]. The first exhaust time after the re-operation of the laparoscopic re-surgery group was significantly shorter than the open re-surgery group [2.5(1.8, 3.0) d vs. 3.0(2.0, 6.0) d, P<0.05]. The total length of hospital stay and the total length of hospital stay after the re-surgery in laparoscopic re-surgery group was significantly shorter than the open re-surgery group [23.5(16.5, 34.0) d vs. 29.0(24.5, 35.5) d, 6.5(4.8, 13.8) d vs. 11.5(8.0, 16.8) d, all P<0.05]. Conclusion The laparoscopic re-surgery for treatment of anastomotic leakage after initial laparoscopic colorectal surgery is safe and feasible and has a better short-term therapeutic effect compared with traditional open re-surgery.