单向倒刺线在腹腔镜辅助直肠癌经腹会阴联合切除术盆底重建中的应用

Application of unidirectional barb line in peritoneoscopically assisted perineal combined resection for pelvic floor reconstruction of rectal cancer

目的:探讨单向倒刺线应用于腹腔镜辅助直肠癌经腹会阴联合切除术盆底重建中的可行性。方法:研究对象为深圳市中西医结合医院2018年8月至2020年8月收治的因患低位直肠癌行腹腔镜辅助直肠癌经腹会阴联合切除术的患者,共60例。根据术后关闭盆底腹膜方法的不同将其分为单向倒刺线关闭盆底腹膜组、连续可吸收线关闭盆底腹膜组和不关闭盆底腹膜组〔三组患者的基本资料(年龄、肿瘤病理类型、肿瘤位置、肿瘤分期、肿瘤分化程度等)无显著差异(P>0.05),具有可比性〕。观察三组患者的手术时间、术中盆底关闭时间、术中出血量、术后疼痛持续的时间、术后骶前引流量、引流管拔除时间、术后住院时间、术后并发症(盆底疝、肠瘘、腹腔感染、盆底脓肿、放射性小肠炎、粘连性肠梗阻)的发生率。结果:三组患者均顺利完成腹腔镜辅助直肠癌经腹会阴联合切除术,无患者术中中转开放手术。单向倒刺线关闭盆底腹膜组的手术时间及术中盆底关闭时间较连续缝合关闭盆底腹膜组短,差异有统计学意义(P<0.05)。单向倒刺线关闭盆底腹膜组的术中出血量、术后疼痛持续的时间、术后骶前引流量、引流管拔除时间、术后住院时间与连续缝合关闭盆底腹膜组相比,无明显差异(P>0.05)。单向倒刺线关闭盆底腹膜组、连续缝合关闭盆底腹膜组的术后骶前引流量均较不关闭盆底腹膜组小,引流管拔除时间均较不关闭盆底腹膜组短,差异有统计学意义(P<0.05)。所有患者均于术后1个月内顺利出院,无因手术及术后并发症而死亡的患者。在术后,不关闭盆底腹膜组中有1例患者发生部分小肠进入盆底形成粘连导致的肠梗阻,行二次急诊手术后痊愈;有1例患者发生盆腔积液形成脓肿,经抗感染、调整引流管行双腔冲洗治疗后痊愈;有1例患者发生会阴切口感染,经保守治疗后痊愈。单向倒刺线关闭盆底腹膜组、连续缝合关闭盆底腹膜组的术后并发症发生率均较不关闭盆底腹膜组低,差异有统计学意义(P<0.05)。结论:使用单向倒刺线在腹腔镜辅助直肠癌经腹会阴联合切除术中进行盆底腹膜重建的效果较好,不会增加患者术后并发症的发生率。此盆底腹膜重建方法可作为进行腹腔镜辅助直肠癌经腹会阴联合切除术盆底重建的可靠选择。

Objective:To investigate the feasibility of uniaxial barb line in laparoscopic assisted perineal combined resection for pelvic floor reconstruction of rectal cancer.Methods:The study subjects were 60 patients who underwent laparoscopic-assisted transabdominal perineal resection for low rectal cancer treated in Shenzhen Hospital of Integrated Traditional and Western Medicine from August 2018 to August 2020.According to the different methods of closing the pelvic floor peritoneum after operation,they were divided into the unidirectional barb line closing the pelvic floor peritoneum group,the continuous absorbable line closing the pelvic floor peritoneum group and the non-closing the pelvic floor peritoneum group.The basic data(age,tumor pathological type,tumor location,tumor stage,tumor differentiation degree,etc.)of the three groups had no significant difference(P>0.05),and were comparable.The operation time,intraoperative pelvic floor closing time,intraoperative blood loss,duration of postoperative pain,postoperative anterior sacral drainage volume,time of drainage tube removal,postoperative hospital stay,and incidence of postoperative complications(pelvic floor hernia,intestinal fistula,abdominal infection,pelvic floor abscess,radioactive enteritis,and adhesive intestinal obstruction)of the three groups were observed.Results:All patients in the three groups successfully completed laparoscopic assisted transabdominal perineal combined resection for rectal cancer,and no patients switched to open surgery during the operation.The operation time and intraoperative closing time of the pelvic floor in the unidirectional barb suture group were shorter than those in the continuous suture group,and the difference was statistically significant(P<0.05).There were no significant differences in intraoperative blood loss,postoperative pain duration,postoperative anterior sacral drainage volume,drainage tube removal time,and postoperative hospital stay in the unidirectional barb line closing pelvic floor peritoneum group compared with the continuous suture closing pelvic floor peritoneum group(P>0.05).The postoperative anterior sacral drainage volume in the unidirectional barb line closing pelvic floor peritoneum group and the continuous suture closing pelvic floor peritoneum group was smaller than that in the non-closing pelvic floor peritoneum group,and the drainage tube removal time was shorter than that in the non-closing pelvic floor peritoneum group,with statistical significance(P<0.05).All patients were discharged from the hospital successfully within 1 month after surgery,and no patients died due to surgery and postoperative complications.After surgery,1 patient in the group without the pelvic floor peritoneum closure suffered from intestinal obstruction caused by adhesion of part of small intestine into the pelvic floor,which was recovered after second emergency operation.One patient developed pelvic effusion and formed abscess,which was cured after anti-infection and double-cavity irrigation with drainage tube adjustment.One patient developed perineal incision infection,which was cured after conservative treatment.The incidence of postoperative complications in the unidirectional barb line closing pelvic floor peritoneum group and continuous suture closing pelvic floor peritoneum group was lower than that in the non-closing pelvic floor peritoneum group,and the difference was statistically significant(P<0.05).Conclusion:The use of unidirectional barb line in peritoneal peritoneal reconstruction of laparoscopic assisted transabdominal perineal resection for rectal cancer is better and does not increase the incidence of postoperative complications.This method of pelvic floor peritoneal reconstruction can be used as a reliable choice for peritoneoscopically assisted perineal combined resection of pelvic floor for rectal cancer.