部分横结肠皮下潜行在腹腔镜中低位直肠癌前切除术的应用

The application of partial transverse colon subcutaneous exteriorization in anteriorresection of low rectal cancer in peritoneoscope

目的探讨部分横结肠皮下潜行(预造口)在腹腔镜中低位直肠癌前切除术中的应用价值.方法回顾性分析2017年2月至2019年2月34例腹腔镜直肠癌中低位前切除加行保护性横结肠皮下潜行术患者的围手术期相关资料.结果所有患者均顺利完成Ⅰ期手术,无死亡病例.患者Ⅰ期手术时间平均(220.6±30.4)min、出血量(117.5±37.2)ml、平均住院时间(9.2±1.7)d、住院费用平均(4.21±1.58)万.以亚甲蓝液灌注试验诊断吻合口漏5例(14.7%),确诊后均在床边局部麻醉下改行传统横结肠造口.改行横结肠造口的5例患者中1例出现造口旁感染,经换药引流治愈,未见其他严重并发症.排除吻合口漏的患者29例,均于术后1周局部麻醉下缝合潜行肠管上方的皮肤裂口.平均随访时间7~22(12.2±3.8)个月.5例改行传统横结肠造口的患者均于术后5~7(5.6±2.1)个月内行造口回纳,手术顺利,术后无严重并发症.永久横结肠局部皮下潜行的患者共29例,随访期间发生小肠粘连性梗阻2例,1例保守治疗后好转,另1例留置肠梗阻导管治疗后痊愈.期间CT或钡灌肠造影检查未见与横结肠皮下潜行相关的切口疝、肠梗阻、肠扭转等并发症.结论腹腔镜直肠前切除后行保护性横结肠潜行安全可行,对于吻合口漏高危患者是一种可供选择的预防措施.

Objective To evaluate the value of protective transverse colon subcutaneous exteriorization(PTCSE)in laparoscopic anterior resection for middle and low rectal cancer.Methods From February 2017 to February 2019,the clinical data of 34 patients underwent laparoscopic anterior resection alongside PTCSE for middle and low rectal cancer were retrospectively analyzed.Results All patients were perfomied successful operation without death.The average operation time was 220.6±30.4minutes,the bleeding volume was 117.5±37.2nil,the hospitalization time was 9.2±1.7 days and the hospitalization expenses was 42.1±15.8 thousand yuan respectively.Five cases(11.4%)o f anastomotic leakage were diagnosed by methylene blue perfusion test.After diagnosis,they were all converted to traditional transverse colostomy under local anesthesia.One of the 5 patients who underwent transverse colostomy developed parastomal infection and was cured by drainage,and the others were without any more serious complications.29 patients who were free o f the anastomotic leakage were sutured incision under local anesthesia 1 week after operation.Follow up was 9〜22(mean 12.2±2.8)months.All the 5 patients who were converted to traditional transverse colostomy received the operation within 3-6 months after the operation.The operation was successful without serious complications.During the follow-up period,there were 2 cases of intestinal adhesive obstruction,1 case improved after conservative treatment,and 1 case recovered after indwelling intestinal obstrucrion catheter.There were no incisional hernia,intestinal obstruction,volvulus and other complications associated with PTCSE diagnosed by CT or barium enema.Conclusion Laparoscopic anterior rectal resection with PTCSE is safe and feasible,and it is an alternative preventive measure for high-risk patients with anastomotic leakage.