直肠癌腹腔镜Miles手术中应用带蒂大网膜重建盆底预防术后近期并发症的疗效

Pedicled omentum packing of the pelvic floor in the prevention of short-term postoperative complications after laparoscopic Miles precedure

目的介绍带蒂大网膜应用于腹腔镜腹会阴联合直肠癌根治术盆底重建预防术后近期并发症的临床疗效。方法回顾性分析2014年1月—2021年8月河南省肿瘤医院普外科行腹会阴联合直肠癌根治术术中盆底腹膜不能直接缝合关闭的72例患者的临床资料,观察组35例利用带蒂大网膜行盆底重建,对照组37例未关闭盆底腹膜。结果观察组患者未出现肠梗阻,对照组出现5例肠梗阻,与小肠坠入骶前术区有关。3例经保守治疗后痊愈,2例手术探查,其中1例行肠粘连松解,1例行小肠小肠吻合。两组患者肠梗阻发生率相比差异有统计学意义(0比14%,χ^(2)=5.083,P=0.024)。两组患者手术时间、住院时间相比差异有统计学意义[(195±13)min比(159±9)min,t=10.047,P=0.000;(11.9±0.9)d比(14.9±2.1)d,t=-5.996,P=0.000]。两组患者骶前感染、肺部感染、静脉血栓发生率、术中出血量相比差异均无统计学意义(均P>0.05)。结论带蒂大网膜应用于腹腔镜腹会阴联合直肠癌根治术盆底重建可在一定程度上降低术后近期并发症发生率,特别是肠梗阻的发生率。

Objective To evaluate the effect of pedicled omentum packing of pelvic floor after laparoscopic Miles precedure in the prevention of short-term postoperative complications.Methods Seventy-two patients undergoing laparoscopic combined abdominal perineal resection for rectal cancer at He'nan Tumor Hospital from Jan 2014 to Aug 2021 were retrospectively reviewed.The observation group underwent pelvic floor reconstruction with pedicled omentum,while in control group the pelvic floor was leaving unconstructed.Results There was no intestinal obstruction in the observation group.There were 5 cases of intestinal obstruction in the control group.Three were recovered by conservative treatment,2 cases underwent laparotomy and 1 case underwent anastomosis between small intestine and small intestine.The incidence of intestinal obstruction between 2 groups was statistically different(0 vs.14%,χ^(2)=5.083,P=0.024).The operation time,hospital stay between the two groups were statistically different[(195±13)min vs.(159±9)min,t=10.047,P=0.000;(11.9±0.9)d vs.(14.9±2.1)d,t=-5.996,P=0.000].Between the two groups,there were no significant differences in the incidence of presacral infection,pulmonary infection,venous thrombosis and intraoperative blood loss(all P>0.05).Conclusion Pedicled greater omentum used in pelvic floor reconstruction after laparoscopic Miles procedure reduces the incidence of short-term postoperative complications,especially of intestinal obstruction.