吻合口加固缝合与盆底腹膜重建在腹腔镜直肠癌前切除术中的临床应用研究

Clinical application of anastomotic reinforcement suture and pelvic peritoneal reconstruction in laparoscopic anterior resection of rectal cancer

目的探讨吻合口加固缝合与盆底腹膜重建在腹腔镜直肠癌前切除术中临床应用价值。方法选择2019年6月~2021年6月间山西省肿瘤医院结直肠肛门外科收治的260例行腹腔镜直肠癌前切除术治疗患者为研究对象。采用随机数字表法将患者随机分为两组,各130例。观察组为吻合口加固缝合及盆底腹膜重建组,对照组为常规吻合组。观察手术及术后恢复情况,并对腹腔镜直肠癌前切除术后吻合口漏的危险因素进行分析。结果两组共21例患者发生吻合口漏,吻合口漏发生率为8.08%(21/260),其中观察组吻合口漏4例,均为B级漏;对照组吻合口漏17例,其中B级漏10例,C级漏7例,两组在吻合口漏方面差异有统计学意义(χ^(2)=8.755,P=0.003)。观察组均未行二次手术,对照组9例行二次手术,两组差异有统计学意义(χ^(2)=9.409,P=0.002)。观察组手术时间长于对照组,差异有统计学意义(t=18.804,P<0.001)。观察组发生粘连性肠梗阻2例,对照组发生粘连性肠梗阻8例,差异有统计学意义(χ^(2)=4.262,P=0.039)。单因素分析结果显示:性别、糖尿病、高血压、NRS 2002评分、肿瘤长径、肿瘤距肛缘距离、手术时间、直线切割闭合器使用次数、淋巴结转移情况、吻合口是否加固缝合是影响腹腔镜直肠癌前切除术后吻合口漏的相关因素(P<0.05)。多因素分析结果显示:吻合口未加固缝合(β=2.775,OR=16.042,95%CI:2.186~117.754)、NRS 2002评分≥3分(β=3.918,OR=50.298,95%CI:10.836~233.484)、肿瘤距肛缘距离≤5 cm(β=1.858,OR=6.409,95%CI:1.410~29.129)是影响腹腔镜直肠癌前切除术后吻合口漏的独立危险因素。结论吻合口加固缝合及盆底腹膜重建可明显减少吻合口漏的发生,缓解吻合口漏发生的后果,减少二次手术率,同时可预防术后粘连性肠梗阻的发生,值得推广应用。

ObjectiveTo explore the clinical value of anastomotic reinforcement suture and pelvic peritoneal reconstruction in laparoscopic anterior resection of rectal cancer.Methods260 patients who underwent laparoscopic anterior resection of rectal cancer in the Department of Colorectal and Anal Surgery of Shanxi Province Cancer Hospital from June 2019 to June 2021 were selected as the study subjects. Patients were randomly divided into two groups with 130 cases in each group by random number table method. The observation group was anastomotic reinforcement suture and pelvic peritoneal reconstruction group, and the control group was routine anastomosis group. Observation indicators: intraoperative and postoperative situations;analysis of risk factors of anastomotic leakage after laparoscopic anterior resection of rectal cancer.ResultsA total of 21 patients in the two groups had anastomotic leakage, and the incidence of anastomotic leakage was 8.08% (21/260). There were 4 cases of anastomotic leakage in the observation group, all of which were grade B leakage, and 17 cases of anastomotic leakage in the control group, including 10 cases of grade B leakage and 7 cases of grade C leakage. The two groups were statistically significant (χ^(2)=8.755, P=0.003). No secondary operation was performed in the observation group, and 9 cases in the control group. The two groups were statistically significant (χ^(2)=9.409, P=0.002). The operation time of the observation group was longer than that of the control group, the difference was statistically significant (t=18.804, P=0.001). There were 2 cases of adhesive intestinal obstruction in the observation group and 8 cases of adhesive intestinal obstruction in the control group, the difference was statistically significant (χ^(2)=4.262, P=0.039). The results of univariate analysis showed that gender, diabetes, hypertension, NRS 2002 score, tumor length, tumor distance from anal margin, operation time, times of using linear cutting closure device, lymph node metastasis, anastomotic reinforcement suture is a related factor affecting anastomotic leakage after laparoscopic anterior resection of rectal cancer (P<0.05). Multivariate analysis showed that the anastomotic leakage after laparoscopic anterior resection of rectal cancer was affected by the independent risk factors of anastomotic leakage after laparoscopic anterior resection of rectal cancer, including unreinforced anastomotic suture (β=2.775, OR=16.042, 95%CI: 2.186~117.754), NRS 2002 score ≥3 (β=3.918, OR=50.298, 95%CI: 10.836~233.484), and distance from tumor to anal margin ≤5 cm (β=1.858,OR=6.409,95%CI: 1.410~29.129).ConclusionsAnastomotic reinforcement and suture and pelvic peritoneal reconstruction can significantly reduce the occurrence of anastomotic leakage, alleviate the consequences of anastomotic leakage, reduce the rate of secondary surgery, and prevent the occurrence of postoperative adhesive intestinal obstruction, which is worthy of promotion and application.