单吻合器双荷包吻合法在腹腔镜下低位直肠癌前切除术中的应用

Application of single stapling technique with double purse-string suture during laparoscopic anterior resection for rectal cancer

目的:评估单吻合器双荷包吻合法在腹腔镜下低位直肠癌前切除术中应用的有效性和安全性。方法:103例直肠癌患者,男56例,女47例,肿瘤下缘距离肛缘3~5 cm且病理学确诊为直肠腺癌,均接受腹腔镜下低位直肠癌前切除术,术中采用单吻合器双荷包吻合(A组)56例,采用全手工缝合(B组)47例。比较两组患者术中术后的情况。结果:两组患者均顺利完成手术,无中转开腹,无术中或术后死亡病例。A、B组清扫淋巴结数分别为(15.8±6.4)、(15.3±7.2)枚,吻合口距肛缘距离分别为(2.1±1.4)、(2.2±1.7)cm,差异均无统计学意义(P>0.05)。两组手术时间、术中出血量、行保护性回肠造瘘患者比例、吻合口瘘和吻合口出血发生率、首次排气时间、直肠刺激征发生率比较,差异均无统计学意义(P>0.05)。A组吻合口狭窄发生率为1.8%,B组为17.0%,A组低于B组(P<0.05)。结论:单吻合器双荷包吻合法是一种安全、可行且有优势的腹腔镜下低位直肠癌前切除术中结肛吻合方法。

Aim:To evaluate the feasibility and safety of single stapling technique with double purse-string suture for rectal cancer patients undergoing laparoscopic low anterior resection.Methods:The data of 103 rectal cancer patients undergoing laparoscopic low anterior resection were analyzed,including 56 males and 47 females.The distance from the lower margin of the tumor to the anal margin was 3-5 cm,and the pathological diagnosis was rectal adenocarcinoma.Fifty-six cases received single stapling technique with double purse-string suture(SSDPS group),and 42 cases received hand-sewn technique(HS group).Clinical conditions during operation and after operation were compared between the two groups.Results:All the patients underwent operation successfully without transferring to laparotomy and intro-operative or post-operative death.The number of dissected lymph nodes in group A and B was(15.8±6.4),(15.3±7.2),respectively,and the distance between anastomotic opening and anal margin were(2.1±1.4),(2.2±1.7)cm,respectively,with no significant difference between the two groups(P>0.05).There were no significant difference in operation time,intraoperative bleeding volume,proportion of protective ileostomy,incidence of anastomotic bleeding or anastomotic fistula,recovery time of exhaust gas,incidence of rectal irritation between the two groups(P>0.05).The incidence of stenosis were 1.8%in group A,17.0%in group B,respectively,and those in group A were lower than in group B(P<0.05).Conclusion:Single stapling technique with double purse-string suture coloanal anastomosis is safe and feasible for low rectal cancer in laparoscopic rectal surgery.