截石位经会阴横弧形切口手术入路在完全切除骶前囊肿术中的应用价值

Application value of transverse perineal arc incision approach in complete resection of presacral cyst in the lithotomy position

目的探讨截石位经会阴横弧形切口手术入路在完全切除骶前囊肿术中的应用价值。方法采用回顾性队列研究方法。收集2012年8月至2021年10月河南省肿瘤医院收治的114例行完全切除骶前囊肿术患者的临床病理资料;男14例,女100例;年龄为(35±9)岁。所有患者术前磁共振成像(MRI)检查诊断为骶前囊肿。114例患者中,76例术中采用截石位经会阴横弧形切口手术入路,设为创新组;38例术中采用Kraske手术入路,设为传统组。观察指标:(1)手术及标本情况。(2)术后情况。(3)随访情况。正态分布的计量资料以x±s表示,组间比较采用t检验;偏态分布的计量资料以M(范围)表示,组间比较采用Mann‑Whitney U检验。计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验或Fisher确切概率法。结果(1)手术及标本情况。创新组患者手术时间,术中出血量,术中联合经腹入路或切除骶骨例数分别为(137±20)min,(261±101)mL,0;传统组患者上述指标分别为(136±34)min,(261±116)mL,15例;两组患者手术时间和术中出血量比较,差异均无统计学意义(t=0.18,0,P>0.05);两组患者术中联合经腹入路或切除骶骨例数比较,差异有统计学意义(P<0.05)。两组患者术后标本解剖均显示囊肿完全切除。(2)术后情况。创新组患者术后骶前引流管拔除时间,术后住院时间,术后切口Ⅱ期愈合例数分别为(11.4±2.1)d,(13.5±3.5)d,23例;传统组患者上述指标分别为(11.5±1.9)d,(13.7±3.8)d,4例;两组患者术后骶前引流管拔除时间和术后住院时间比较,差异均无统计学意义(t=-0.20,-0.24,P>0.05);两组患者术后切口Ⅱ期愈合例数比较,差异有统计学意义(χ^(2)=5.46,P<0.05)。创新组患者和传统组患者术后出现严重并发症例数分别为4例和2例,两者比较,差异无统计学意义(P>0.05)。(3)随访情况。114例患者均获得随访,随访时间为48(6~108)个月。创新组患者中,2例囊肿复发,传统组患者术后无囊肿复发;两组患者术后囊肿复发例数比较,差异无统计学意义(P>0.05)。随访期间,患者肛门控便功能评价均为Williams分级A~B级。结论截石位经会阴横弧形切口手术入路用于完全切除骶前囊肿术安全、可行;与Kraske手术入路比较,其更适用于高位骶前囊肿患者。

Objective To investigate the application value of transverse perineal arc incision approach in complete resection of presacral cyst in the lithotomy position.Methods The retrospective cohort study was conducted.The clinicopathological data of 114 patients who underwent complete resection of presacral cyst in Henan Cancer Hospital from August 2012 to October 2021 were collected.There were 14 males and 100 females,aged(35±9)years.All patients were diagnosed as presacral cysts by preoperative magnetic resonance imaging.Of the 114 patients,76 patients undergoing intraoperative perineal arc incision approach in the lithotomy position were divided into the innovative group,and 38 patients undergoing intraoperative Kraske approach were divided into the traditional group.Observation indicators:(1)surgical situations and specimen;(2)postoperative situations;(3)Follow-up.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was conducted using the Mann-Whitney U test.Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test or Fisher exact probability.Results(1)Surgical situations and specimen.The operation time,volume of intraoperative blood loss,cases with intraoperative combined transabdominal approach or sacrectomy were(137±20)minutes,(261±101)mL,0 in the innovation group,versus(136±34)minutes,(261±116)mL,15 in the traditional group,showing no significant difference in the operation time and volume of intraoperative blood loss between the two groups(t=0.18,0,P>0.05)and showing a significant difference in cases with intraoperative combined transabdominal approach or sacrectomy between the two groups(P<0.05).Results of postoperative specimen anatomy in patients of the two groups showed complete removal of the cyst.(2)Postoperative situations.The time to postoperative removing presacral drainage tube,duration of postoperative hospital stay,cases with postoperative second stage healing of incision were(11.4±2.1)days,(13.5±3.5)days,23 in the innovation group,versus(11.5±1.9)days,(13.7±3.8)days,4 in the traditional group,showing no significant difference in the time to postoperative removing presacral drainage tube and duration of postoperative hospital stay between the two groups(t=−0.20,−0.24,P>0.05)and showing a significant difference in cases with postoperative second stage healing of incision between the two groups(χ^(2)=5.46,P<0.05).Cases with postoperative severe complications were 4 and 2 in the innovation group and the traditional group,respectively,showing no significant difference between the two groups(P>0.05).(3)Follow-up.All 114 patients were followed up for 48(range,6‒108)months.Cases with recurrence of cysts were 2 and 0 in the innovation group and the traditional group,respectively,showing no significant difference between the two groups(P>0.05).During the follow-up period,the anal defecation control function of all patients was classified as grade A‒B of Williams score.Conclusions The transverse perineal arc incision approach in complete resection of presacral cyst in the lithotomy position is safe and feasible.Compared with Kraske approach,the transverse perineal arc incision approach in the lithotomy position is more suitable for patients with high presacral cyst.