双吻合器联合经肛加固缝合吻合口在腹腔镜直肠癌根治术中的应用

Double stapling combined with transanal suture to strengthen anastomosis for laparoscopic radical resection for rectal cancer

目的观察双吻合器联合经肛加固缝合吻合口在中低位直肠癌TME术中的应用效果。方法回顾性分析本院2018年8月至2019年10月收治的97例择期行腹腔镜直肠癌TME术并完成双吻合器法消化道重建患者的临床资料。根据器械吻合后是否进行加固缝合吻合口分为观察组(经肛加固缝合,n=53)与对照组(未加固缝合,n=44)。记录患者手术相关指标、术后病理、术后恢复、术后并发症发生情况,以及造口还纳前肠镜下吻合口愈合情况。结果两组手术时间、术中出血量、吻合口距肛缘距离、远切缘使用闭合器数量、小肠造口率、下切缘距肿瘤距离、淋巴结清扫数目比较差异均无统计学意义(均P>0.05)。所有病例术后肿瘤切缘均为阴性,CRM切缘均完整。两组术后肠道通气时间、恢复进食时间、留置导尿时间、住院时间比较差异均无统计学意义(均P>0.05)。观察组术后并发症总发生率低于对照组(P<0.05)。造口还纳前行肠镜检查(对照组有1例患者未完成造口还纳),可见对照组吻合口常伴有肉芽增生及典型的直线吻合器处理后残角,观察组吻合口则呈管型通畅平顺,无肉芽增生及残角。结论在中低位直肠癌TME术中使用双吻合器法进行消化道吻合重建后经肛加固缝合吻合口操作简便,可提高吻合口愈合质量。

Objectives To investigate the effectiveness of double stapling combined with transanal suture to strengthen anastomosis for total mesorectal excision(TME)in patients with mid-and low rectal cancer.Methods This was a retrospective analysis of 97 patients who underwent elective laparoscopic TME for rectal cancer and double stapling anastomosis at our hospital between August 2018 and October 2019.Depending on whether transanal suture to strengthen anastomosis was performed,patients were divided into the treatment group(n=53,receiving transanal suture)and control group(n=44,not receiving transanal suture).Surgical parameters,postoperative pathology,postoperative recovery,complications,and anastomosis status under colonoscopy before stoma reversal were recorded and compared between the two groups.Results The two groups did not differ significantly in operation time,intraoperative blood loss,the distance from anastomosis to anal verge,number of closure devices used for distal resection,rate of ileostomy,the distance from inferior margin to tumor,and lymph node yield(P>0.05).In all patients,resection margins were negative,and the mesorectum was complete.Postoperative time to flatulence,time to food intake,time to remove Foley catheter,and duration of hospitalization were similar between the two groups(P>0.05).The incidence of complications was significantly lower in the treatment group than in the control group(P<0.05).One patient in the control group did not have stoma reversal.In the remaining patients,colonoscopy before stoma reversal showed that patients in the control group had proliferation in the granulation tissues at the anastomosis and typical remnants after stapling,while patients in the treatment group had smooth tubes of the anastomosis and no signs of granulation or remnants after stapling.Conclusion In patients with mid-and low rectal cancer who undergo TME,combining double stapling with transanal suture to strengthen anastomosis is a simple procedure that can improve the quality of anastomotic healing.