盆底重建在直肠癌腹腔镜低位直肠前切除术中的意义和方法

Significance and techniques of pelvic floor reconstruction in laparoscopic low anterior resection for rectal cancer

腹腔镜低位直肠癌前切除术形成的盆底残腔容易导致盆腔感染扩散、粘连性肠梗阻,并可能增加放疗患者放射性肠损伤发生概率。手术中重建盆底能够避免小肠坠入骶前残腔,减少肠梗阻和放射性肠损伤的风险,预防或减轻吻合口漏等并发症的发生及其严重程度,还能够在一定程度上改善低位前切除术后肛门功能,提高患者生命质量。直接缝合盆底腹膜和带蒂大网膜填充是目前常用的2种盆底重建方式,操作较为简单,容易推广,值得常规应用。

The residual pelvic floor cavity formed by laparoscopic low anterior resection for rectal cancer can result in some complications,such as spread of pelvic infection following anastomotic leakage,adhesive intestinal obstruction,and may increase the probability of radiation intestinal injury in case of postoperative radiotherapy.Reconstructing the pelvic floor can prevent the small intestine from entering the residual cavity,reduce the risk of intestinal obstruction and radiation induced intestinal injury;prevent or reduce the occurrence and severity of anastomotic leakage.Reconstructing the pelvic floor can also improve the anal function after low anterior resection to a certain extent and enhance the quality of life of patients.Direct suturing of the pelvic floor peritoneum and pedicled greater omentum flap graft transplantation are currently two commonly used pelvic floor reconstruction methods,which are relatively simple to operate,easy to promote,and worthy of routine application.