用于机器人中低位直肠癌术后预防吻合口漏的一项新技术研究

An innovative technique to prevent low rectal anastomotic leakage in robotic rectal surgery

目的:吻合口漏(anastomotic leakage,AL)是低位直肠癌保肛术后的严重并发症,亟需确切有效的预防措施。本研究旨在评估机器人低位直肠癌前切除术(low anterior resection,LAR)联合创新技术预防AL的临床价值。方法:选取2012年5月至2017年5月,于复旦大学附属中山医院接受机器人LAR治疗的601例患者,其中191例患者为对照组(non-PST组),410例患者为治疗组(PST组)。分析比较两组AL发生率、围手术期结局和长期生存率;多因素回归分析机器人LAR术后AL的高危因素。结果:依据ISREC分级,601例患者的总体AL发生率为6.8%,其中B级为5.7%,C级为1.1%。其中PST组的总体AL发生率(5.1%)明显低于non-PST组(10.5%,P=0.015);PST组的C级AL也明显改善(0.2%vs.3.2%,P=0.005)。此外,PST组的手术并发症率(17.3%vs.20.9%,P=0.286)和再手术率(2.7%vs.6.3%,P=0.038)较non-PST组均显著降低。长期结局分析提示两组的局部复发率和长期生存率无显著差异。多因素回归分析提示non-PST技术、术中出血量≥100 mL、吻合口距离肛缘<5 cm以及远端切缘距离肿瘤<2 cm分别是机器人LAR术后AL发生的高危因素。结论:机器人LAR联合PST技术是一种有效预防AL的方法,在临床实践中可避免常规实施保护性造口术。

Objective:To assess the role of an innovative technique in preventing anastomotic leakage(AL)in rectal cancer patients undergoing robotic low anterior resection(LAR).Methods:From May 2012 to May 2017,we included 601 patients who underwent robotic LAR:410 patients underwent the innovative technique(PST group)and 191 patients were control subjects(non-PST group).We analyzed and compared the AL rate and short-term and long-term outcomes between the groups.Results:Using the ISREC grading system,the overall rate of AL was 6.8%(5.7%for Grade B and 1.1%for Grade C).The PST group had a lower incidence of overall AL(5.1%vs.10.5%,P=0.015)and Grade C AL(0.2%vs.3.2%,P=0.005)and lower rates of reoperation(2.7%vs.6.3%,P=0.038)than the non-PST group;furthermore,both groups had similar surgical complication rates(17.3%vs.20.9%,P=0.286).Short-term recovery and longterm oncological outcomes did not significantly differ between the two groups.Using multivariate Logistic regression models,the risk factors of AL in robotic LAR were the non-PST technique,an estimated blood loss≥100 mL,anastomosis from anal verge<5 cm,and a distal resection margin from tumors<2 cm.Conclusions:The innovative PST technique may be an effective method in preventing the occurrence of AL in robotic LAR.