盲肠/子宫填充盆底缺损在腹腔镜Miles术中临床应用研究

Clinical application of filling pelvic floor defect with caecum/uterus in laparoscopic Miles′ operation

目的:探讨腹腔镜下低位中晚期直肠癌手术后行盆底盲肠/子宫填充与术后盆底不关闭比较对于患者术后早期恢复的优势。方法:在安徽医科大学第一附属医院东城院区外科三病区实施腹腔镜下直肠癌Miles术患者中,随机选择2019年3月~2020年6月的盆底不关闭患者20例作为传统组;随机选择2020年6月~2021年9月行盆底盲肠/子宫填充术患者20例作为优化组,通过统计资料对两组术后早期并发症及相关术后指标进行回顾性分析。结果:优化组手术后会阴疝、餐后(半流质)腹胀情况低于传统组(P<0.05);手术时间较传统组长(P<0.05);两组患者术中失血量、术后引流量、术后肛门排气时间、半流质开始时间、术后腹壁切口感染、盆腔感染及造口旁疝发生率比较差异无统计学意义(P>0.05)。结论:盆底盲肠/子宫填充术对于中晚期低位直肠癌Miles术后恢复有积极有效的作用。

Objective:To compare effects of repairing the defect of pelvic floor with caecum/uterus or not-closing pelvic floor on early recovery in patients of low rectal cancer at mid-and advanced stage after laparoscopic surgery.Methods:Twenty patients with pelvic floor unsutured were randomly included in conventional surgery group from those undergone laparoscopic Miles′operation for rectal cancer in our hospital between March 2019 and June 2020,and another 20 patients with pelvic floor repaired with caecum/uterus were randomly included in observational group from those treated between June 2020 and September 2021.The two groups were retrospectively and statistically analyzed regarding the early complications and related indicators after surgery.Results:Incidences of postoperative perineal hernia(PH)and postprandial(semifluid)abdominal distension were significantly lower in the observational group than in the conventional surgery group(P<0.05).The operation time of the observational group was longer than that of the conventional surgery(P<0.05),yet there was no significant difference between the two groups in intraoperative blood loss,postoperative drainage volume,postoperative anal exhaust time,the time to start intake of semifluid diet as well as postoperative abdominal incision infection,pelvic infection and the incidence of parastomal hernia(P>0.05).Conclusion:Filling the pelvic floor with caecum/uterine can effectively lead to early recovery in patients of low rectal cancer at mid-and advanced stage after laparoscopic surgery.