手工吻合消化道重建在完全腹腔镜低位直肠癌根治术中的应用

Application of Manual Anastomotic Gastrointestinal Reconstruction in Complete Laparoscopic Radical Resection of Low Rectal Cancer

目的探讨手工吻合消化道重建在完全腹腔镜低位直肠癌根治术中的临床应用价值。方法选择2020年1月—2021年7月泰安市中医二院收治的低位直肠癌行腹腔镜下根治术患者80例。随机分为两组,各40例。观察组行手工吻合,对照组行常规吻合器吻合,对所有入组者随访3个月,比较两组吻合耗时、切除肿瘤与切缘距离和术中清扫淋巴结数量,统计两组随访期间Wexner便失禁评分情况,比较两组术后并发症,如发生吻合口漏、吻合口狭窄、术后出血和腹腔感染的总比例,比较两组术后3个月时肛门功能,如存在排便急促、排便中断、便秘、气便区分困难及大便失禁的比例。结果观察组吻合耗时为(13.5±2.8)min短于对照组,差异有统计学意义(t=3.946,P<0.05);切除肿瘤与切缘距离为(4.3±0.8)cm大于对照组,差异有统计学意义(t=11.103,P<0.05);术中清扫淋巴结数量为(15.8±2.8)个多于对照组,差异有统计学意义(t=4.860,P<0.05);出院时和术后3个月,观察组Wexner便失禁评分为(8.3±1.7)分和(6.5±0.5)分显著低于对照组,差异有统计学意义(t=8.872、19.890,P<0.05);观察组发生吻合口漏、吻合口狭窄、术后出血和腹腔感染的总比例为2例(5.0%)显著低于对照组,差异有统计学意义(χ^(2)=6.275,P=0.012);术后3个月,存在排便急促1例、排便中断1例、便秘1例和气便区分困难1例,以上各并发症比例均低于对照组,差异有统计学意义(χ^(2)=8.538、9.804、8.538、6.275,P<0.05)。结论针对完全腹腔镜下低位直肠癌根治术患者,行手工吻合消化道重建,耗时短,具有较高的术中病灶切除效率和淋巴结清扫率,且并发症少,可有效保留患者术后肛门功能,值得临床推广。

Objective To investigate the clinical application value of manual anastomotic gastrointestinal reconstruction in complete laparoscopic radical resection of low rectal cancer.Methods From January 2020 to July 2021,80 patients with low rectal cancer treated in Tai'an Second Hospital of traditional Chinese medicine underwent laparoscopic radical resection.They were randomly divided into two groups,with 40 cases in each group.The observation group was anastomosed manually and the control group was anastomosed,with conventional stapler.All participants were followed up for 3 months.The anastomotic time,the distance between the tumor and the cutting edge and the number of lymph nodes were compared between the two groups,the Wexner fecal incontinence score was counted during the follow-up period,and the total proportion of postoperative complications such as anastomotic leakage,anastomotic stenosis,postoperative bleeding and abdominal infection was compared between the two groups,The anal function at 3 months after operation was compared between the two groups,such as the proportion of rapid defecation,interrupted defecation,constipation,difficulty in distinguishing between Qi and stool and fecal incontinence.Results The anastomotic time in the observation group was(13.5±2.8)min,which was shorter than that in the control group,the difference was statistically significant(t=3.946,P<0.05);the distance between the tumor and the cutting edge was(4.3±0.8)cm,which was greater than that in the control group,the difference was statistically significant(t=11.103,P<0.05);and the number of lymph nodes cleaned during the operation was(15.8±2.8),which was more than that in the control group,the difference was statistically significant(t=4.860,P<0.05);at discharge and 3 months after operation,the Wexner fecal incontinence score of the observation group was(8.3±1.7)points and(6.5±0.5)points significantly lower than that of the control group(t=8.872,19.890,P<0.05).The total proportion of anastomotic leakage,anastomotic stenosis,postoperative bleeding and abdominal infection in the observation group was 2 cases(5.0%)significantly lower than that of the control group(χ^(2)=6.275,P=0.012);three months after operation,there were 1 case of rapid defecation,1 case of interrupted defecation,1 case of constipation and 1 case of difficulty in distinguishing between Qi and stool.The proportion of the above complications was lower than that of the control group,and the difference was statistically significant(χ^(2)=8.538,9.804,8.538,6.275,P<0.05).Conclusion For patients undergoing complete laparoscopic radical resection of low rectal cancer,manual anastomosis for gastrointestinal reconstruction is time-consuming,has high intraoperative lesion resection efficiency and lymph node dissection rate,and has fewer complications.It can effectively preserve the postoperative anal function of patients and is worthy of clinical promotion.