不同加固方式在腹腔镜低位直肠癌根治术中的临床应用

Clinical Application of Different Reinforcement Methods in Laparoscopic Radical Resection of Low Rectal Cancer

目的探讨不同加固方式在腹腔镜低位直肠癌根治术中的安全性和有效性。方法选取2019年1月~2022年12月于南阳市中心医院行腹腔镜低位直肠癌根治术的215例患者的临床资料进行回顾性分析,根据吻合口加固方式的不同将患者分为经肛加固组(n=63)、经腹加固组(n=69)、未加固组(对照组,n=83);比较3组患者的围术期相关指标、术后并发症(吻合口漏、出血、狭窄)的发生情况及术后肛门直肠功能。结果加固组患者的吻合口漏发生率、吻合口出血数小于未加固组,差异有统计学意义(P<0.05),术中出血量、术后首次排气时间、住院天数、吻合口狭窄、肛门直肠功能比较,差异无统计学意义(P>0.05);经腹加固组比经肛加固组吻合口狭窄发生率高,差异有统计学意义(P<0.05);两组手术时间、术中出血量、术后首次排气时间、住院天数、吻合口漏发生率、吻合口出血数、肛门直肠功能比较,差异无统计学意义(P>0.05)。结论经肛加固低位结直肠吻合口可显著降低术后并发症的发生率,是腹腔镜低位直肠癌根治术中安全有效的加固方式。

Objective To explore the safety and effectiveness of different reinforcement methods in laparoscopic radical resection of low rectal cancer.Methods The clinical data of 215 patients who underwent laparoscopic radical resection of low rectal cancer in Nanyang Central Hospital from January 2019 to December 2022 were analyzed retrospectively.According to the different ways of anastomotic reinforcement,the patients were divided into three groups:transanal reinforcement group(n=63),transabdominal reinforcement group(n=69)and non-reinforcement group(control group,n=83).The perioperative related indexes,postoperative complications(anastomotic leakage,bleeding,stenosis)and postoperative anorectal function were compared among the three groups.Results The incidence of anastomotic leakage and the number of anastomotic bleeding in the reinforcement group were significantly lower than those in the non-reinforcement group,the difference was statistically significant(P<0.05).There was no significant difference in intraoperative blood loss,postoperative first exhaust time,hospital stay,anastomotic stenosis and anorectal function,the difference was not statistically significant(P>0.05).The incidence of anastomotic stenosis in the transabdominal reinforcement group was significantly higher than that in the transanal reinforcement group,the difference was statistically significant(P<0.05).There was no significant difference in operation time,intraoperative blood loss,postoperative first exhaust time,hospital stay,incidence of anastomotic leakage,number of anastomotic bleeding and anorectal function between the two groups,the difference were not statistically significant(P>0.05).Conclusion Transanal reinforcement of low colorectal anastomosis can significantly reduce the incidence of postoperative complications,which is a safe and effective reinforcement method in laparoscopic radical resection of low rectal cancer.