腹纱带牵拉在腹腔镜中低位直肠癌手术中的优势探讨

Advantages of gauze pad band traction in laparoscopic resection of middle-low rectal cancer

目的:探讨腹纱带牵拉直肠在腹腔镜中低位直肠癌根治术中进行手术视野暴露的优势。方法:回顾分析2013年1月至2020年12月接受腹腔镜低位前切除术的中低位直肠癌患者的临床资料,其中505例使用腹纱带牵拉直肠进行术野暴露(A组),358例未使用纱带牵拉直肠(B组),经倾向性评分匹配每组各选取286例患者,对比分析两组术中、术后情况及术后30 d内并发症。结果:倾向性评分匹配后两组患者基线资料差异无统计学意义。A组手术时间短于B组[(205.27±11.88)min vs.(234.09±13.01)min,P<0.001],术中出血量少于B组[(46.52±12.25)mL vs.(68.14±10.75)mL,P<0.001]。两组吻合口高度[(4.33±0.77)cm vs.(4.40±0.81)cm,P=0.318]、中转开腹(52 vs.66,P=0.148)、脾曲游离(130 vs.122,P=0.500)、预防性造口(164 vs.149,P=0.208)、术后首次进食时间[(3.50±1.41)d vs.(3.64±1.52)d,P=0.232]、排气时间[(2.40±0.86)d vs.(2.38±0.99)d,P=0.752]、术后住院时间[(6.93±1.15)d vs.(6.92±1.11)d,P=0.912]、术后并发症数量(46 vs.51,P=0.577)差异均无统计学意义。结论:使用腹纱带牵拉直肠进行手术视野暴露可缩短手术时间、减少术中出血量,术后并发症发生率并未增加,值得临床推广应用。

Objective:To explore the advantages of pulling the rectum with the gauze pad band(GPB)for surgical field exposure in laparoscopic radical resection of middle-low rectal cancer.Methods:The clinical data of patients with middle-low rectal cancer who underwent laparoscopic anterior resection from Jan.2013 to Dec.2020 were retrospectively analyzed.505 patients used GPB to pull the rectum for exposure of the surgical field(group A)and 358 patients did not use GPB to pull the rectum for exposure(group B).The propensity score matching method was used to select 286 patients in each group.Intraoperative outcomes,postoperative outcomes and 30-day postoperative complications were compared between the two groups.Results:There were no statistical differences in baseline information between the two groups after propensity score matching.The operation time[(205.27±11.88)min vs.(234.09±13.01)min,P<0.001]and the intraoperative blood loss[(46.52±12.25)mL vs.(68.14±10.75)mL,P<0.001]were less in the group A.There were no significant differences in anastomotic height[(4.33±0.77)cm vs.(4.40±0.81)cm,P=0.318],conversion to open surgery(52 vs.66,P=0.148),splenic flexure mobilization(130 vs.122,P=0.500),protective ileostomy(164 vs.149,P=0.208),first oral intake[(3.50±1.41)d vs.(3.64±1.52)d,P=0.232]and flatus[(2.40±0.86)d vs.(2.38±0.99)d,P=0.752],the postoperative hospital stay[(6.93±1.15)d vs.(6.92±1.11)d,P=0.912]and the incidence of postoperative complications(46 vs.51,P=0.577).Conclusions:Use of the GPB to pull the rectum for surgical field exposure can shorten the operation time,reduce the a mount of intraoperative bleeding,and does not increase the incidence of complications.This procedure is worthy of clinical promotion and application.