综合牵拉法在腹腔镜辅助低位直肠癌根治术中的应用

Application of the Comprehensive Traction Method in Laparoscopy-assisted Low Anterior Resection for Rectal Cancer

目的探讨综合牵拉法在腹腔镜辅助低位直肠癌根治术(Dixon术)中应用的可行性及效果。方法采用前瞻性随机对照试验,将2017年8月至2019年8月在桂林医学院附属医院胃肠外科行腹腔镜辅助低位直肠癌根治术的82例患者,随机分为常规组(40例)和综合牵拉组(42例)。综合牵拉组采用双绑带牵拉配合子宫(或膀胱腹膜)悬吊法加直肠子宫(膀胱)襞牵拉。常规组采用无损伤钳牵拉显露术野。比较两组手术相关指标、术者对手术野显露的满意度以及临床效果。结果与常规组比较,综合牵拉组术中出血量、直肠充气试验阳性率、术后恢复流质饮食时间、术后住院天数、吻合口瘘发生率及总并发症发生率均无统计学差异(P>0.05)。但综合牵拉组手术时间更短[(169±12)min vs.(182±25)min,P=0.038],使用切割闭合器钉仓数目更少[1(1,2)个vs.2(1,3)个,P=0.048],手术野暴露满意度评分更高(8.0±1.2 vs.6.0±1.5,P=0.003)。结论综合牵拉法有利于手术野暴露,应用于腹腔镜辅助低位直肠癌根治术安全可行。

Objective To investigate the feasibility and effects of comprehensive traction in laparoscopic assisted low anterior resection for rectal cancer.Methods A prospective randomized controlled trial was conducted.82 patients who underwent laparoscopic assisted low anterior resection in the Gastrointestinal Surgery Department of the Affiliated Hospital of Guilin Medical College from August 2017 to August 2019 were randomly divided into the conventional group(40 cases)and the comprehensive traction group(42 cases).In the comprehensive traction group,surgery was performed by double bandage traction combined with uterus(or bladder peritoneum)suspension and rectum uterus(bladder)fold traction.In the conventional group,it was exposed by traction of non-destructive forceps.The operation related indexes,the satisfaction score of the operators and the clinical effects were compared between the two groups.Results Compared with the conventional group,there was no significant difference in the intraoperative bleeding volume,the positive rate of rectal inflation test,time to restore fluid diet,postoperative hospital stay,the incidence of anastomotic leakage and the total complication rate of the comprehensive traction group(P>0.05).However,operation time of the comprehensive traction group was shorter[(169±12)min vs.(182±25)min,P=0.038],the number of stapler cartridge was less[1(1,2)vs.2(1,3),P=0.048],and the satisfaction score of surgical exposure was higher(8.0±1.2 vs.6.0±1.5,P=0.003).Conclusion The comprehensive traction method is beneficial to the exposure of the operating field,and it is safe and feasible for laparoscopic assisted low anterior resection for rectal cancer.