腹腔镜直肠癌低位前切除术中不同缝合方法的回肠双腔造口术临床效果研究

Clinical effect of double ileal stomy with different suture methods during laparoscopic low anterior resection of rectal cancer

目的分析腹腔镜直肠癌低位前切除术中皮内连续缝合和改良一针法在回肠双腔造口术中的临床应用效果。方法回顾性分析2021年1月至2022年12月80例低位直肠癌患者资料,所有患者均行腹腔镜直肠癌低位前切除术+预防性回肠双腔造口术。根据造口缝合方式不同分为两组,观察组39例采用皮内连续缝合方式完成回肠造口,对照组41例采用改良一针法完成回肠造口。应用软件SPSS 22.0处理研究数据。围手术期指标和直肠前切除综合征(LARS)评分等计量资料采用x±s表示,行独立样本t检验;并发症等计数资料采用[例(%)]表示,行χ^(2)检验。P<0.05为差异有统计学意义。结果观察组患者手术时间、造口时间显著短于对照组(P<0.05);观察组患者造口相关并发症总发生率虽低于对照组(2.6% vs.14.6%),但差异未见统计学意义(P>0.05);两组患者造口术后1个月、3个月LARS评分比较,差异无统计学意义(P>0.05),但两组患者造口术后3个月LARS评分显著低于术后1个月(P<0.05)。结论皮内连续缝合和改良一针法回肠双腔造口术在腹腔镜直肠癌低位前切除术治疗低位直肠癌中均是安全有效的,其中皮内连续缝合在不增加术后造口并发症发生率的基础上,明显缩短了手术时间和造口时间,且术后无需拆线,更值得广泛推广应用。

Objective To analyze the clinical effect of continuous intradermal suture and modified one-needle method in double ileal stomy during laparoscopic low anterior resection of rectal cancer.Methods Data of 80 patients with low rectal cancer from January 2021 to December 2022 were retrospectively selected. All patients underwent laparoscopic low anterior resection of rectal cancer plus prophylactic double ileal stomy. They were divided into two groups according to different suture methods. 39 cases in the observation group were completed by intradermal continuous suture, and 41 cases in the control group were completed by improved one-needle method. SPSS 22.0 software was used to process the research data. Measurement data such as perioperative indexes and LARS score were represented by x±s, and independent sample t-test was performed. Complications and other statistical data were represented by [n (%)] and χ^(2) test was performed. P<0.05 was considered statistically significant.Results Operation time and stomy time in observation group were significantly shorter than those in control group (P<0.05). The total incidence of stomation-related complications in the observation group was lower than that in the control group (2.6% vs.14.6%), but the difference was not statistically significant (P>0.05). There was no significant difference in the LARS score 1month and 3 months after stomy between the two groups (P>0.05), but the LARS score 3 months after stomy was significantly lower than that 1 month after surgery (P<0.05).Conclusion Continuous intradermal suture and modified one-needle ileal double-cavity stomy are safe and effective in the treatment of low rectal cancer by laparoscopic low anterior resection. On the basis of not increasing the incidence of postoperative complications, continuous intradermal suture can significantly shorten the operation time and stomy time, and there is no need for postoperative suture removal, so it is worthy of widespread application.