腹腔镜下游离带蒂大网膜预防结直肠癌术后高危吻合口漏的疗效

Effect of laparoscopic free pedicled omentum to prevent high-risk anastomotic leakage after colorectal cancer surgery

目的探讨利用腹腔镜下游离带蒂大网膜包裹吻合口预防结直肠癌术后高危吻合口漏的临床疗效。方法回顾性分析2014年1月至2019年6月在郑州大学附属肿瘤医院普外科行腹腔镜手术切除的239例合并高危因素的结直肠癌患者临床资料,根据术中是否游离带蒂大网膜包裹吻合口分为观察组(115例)及对照组(124例),比较两组患者术中出血量、手术时间、切口长度、术后平均住院时间、吻合口漏的发生率及转归情况。结果(1)观察组3例发生吻合口漏,吻合口漏发生率为2.6%。对照组11例发生了吻合口漏,吻合口漏发生率为8.9%,两组比较差异有统计学意义(P<0.05)。两组患者术中出血量、手术时间、切口长度、术后平均住院时间比较差异无统计学意义(P>0.05)。(2)观察组3例吻合口漏患者经积极保守治疗后好转。对照组11例吻合口漏患者中,3例经积极保守治疗后好转,7例患者行二次手术治疗痊愈出院,1例死亡。结论对于合并高危因素的结直肠癌患者,在不增加切口长度的前提下,腹腔镜下游离带蒂大网膜包裹吻合口可有效降低吻合口漏的发生,是一种安全、有效的防范手段。

Objective To explore the clinical effects of laparoscopic free pedicled omentum in covering high-risk anastomotic stoma after colorectal cancer surgery.Methods A retrospective analysis of clinical data of 239 patients with high-risk anastomotic fistula who underwent laparoscopic colorectal cancer resection at the General Surgery Department of Zhengzhou University Cancer Hospital from January 2014 to June 2019.According to the condition that whether the omentum covered the anastomosis during the operation,they were divided into an experimental group(115 cases)and a control group(124 cases).The intraoperative bleeding volume,operation time,incision length,postoperative hospital stay,rate of anastomotic leakage and outcome were compared between the two groups.Results(1)In the experimental group,3 cases had anastomotic fistulas,and the rate of anastomotic leakage was 2.6%.In the control group,11 cases had anastomotic fistula,and the rate of anastomotic leakage was 8.9%.There was a statistical difference between the two groups(P<0.05).The intraoperative bleeding volume,operation time,incision length,and postoperative hospital stay were no statistical difference between the two groups(P>0.05).(2)Three cases with anastomotic leakage in the experimental group improved after active conservative treatment.In the control group,3 patients improved after active conservative treatment,7 patients were cured by secondary surgery,and 1 patient died.Conclusion For colorectal cancer patients with high-risk factors,laparoscopic free pedicled omentum wrapped anastomotic stoma can effectively reduce the occurrence of anastomotic leakage.It is a safe and effective prevention method.