腹腔镜改良Bacon手术中应用一针外置肠管固定法临床研究

Application of one-stitch externalized colon fixation in modified Bacon surgery

目的 探讨一针外置肠管固定法在腹腔镜下改良Bacon手术中的临床应用价值。方法 回顾性分析2017年1月至2021年10月郑州大学第一附属医院结直肠肛门外科收治的78例行腹腔镜下改良Bacon手术病人的临床资料,根据手术方式分为一针外置肠管固定组(观察组)38例和传统外置肠管固定组(对照组)40例。比较两组病人的手术相关指标、并发症发生率和术后肛门功能情况。结果 两组病人的术中出血量、首次排气时间、首次进食流质时间、术后住院天数、术后并发症的发生率和术后3个月、6个月肠低位前切除综合征(LARS)评分差异均无统计学意义。观察组的外置肠管固定时间短于对照组[1(1,1)min vs.5(4,5)min,Z=-8.256,P=0.031],止痛药物的额外使用率少于对照组(2.6%vs. 17.5%,χ^(2)=4.678,P=0.031),术后疼痛评分低于对照组(P<0.001),差异均有统计学意义。结论 一针外置肠管固定法不但可以减轻腹腔镜下改良Bacon手术的术后疼痛,而且手术操作简单,在临床中的应用安全、有效。

Objective To explore the application value of one-stitch externalized colon fixation in modified Bacon surgery.Methods The clinical data of 78 low rectal cancer patients undergoing modified Bacon surgery in the First Affiliated Hospital of Zhengzhou University from January 2017 to October 2021 were analyzed retrospectively,which were divided into one-stitch externalized colon fixation group(observation group,n=38)and traditional externalized colon fixation group(control group,n=40).The operation-related indicators,the morbidity of postoperative complications and anal function between two groups were compared.Results There were no significant differences in blood loss,first exhaust time,first fluid intake time,postoperative hospitalization time,the incidence of postoperative complications,and low anterior resection syndrome(LARS)score at 3 and 6 months after surgery between the two groups.The externalized colon fixation time of the observation group was shorter than that of the control group[1(1,1)min vs.5(4,5)min,Z=-8.256,P=0.031].The rate of additional analgesic drugs used in the observation group was significantly lower than that in the control group(2.6%vs.17.5%,χ^(2)=4.678,P=0.031),and the postoperative pain scores were significantly lower than those in the control group(P<0.001).Conclusion One-stitch externalized colon fixation can reduce the postoperative pain of modified Bacon surgery,which is easy,safe,and effective in clinical application.