单吻合器结肛吻合在直肠癌腹部无切口术中的价值

The value of colo-anal anastomoses with single-stapling in surgery without abdominal incision for rectal cancer

目的探讨单吻合器结肛吻合在3D腹腔镜腹部无切口低位直肠前切除术的手术方法、安全性及临床运用价值。方法回顾性分析同济大学附属东方医院胃肠肛肠外科从2015年1月至2017年1月120例行3D腹腔镜腹部无切口低位直肠前切除单吻合器结肛吻合术患者的临床资料,总结其手术技巧、效果及安全性。结果 120例患者顺利完成手术,无中转开腹。手术时间(190. 50±20. 71) min、术中出血量(50. 69±15. 21) ml、术后进半流食时间(2. 18±1. 03) d,术后住院时间(9. 56±2. 13) d、术后标本的远切缘及环周切缘为阴性。其中术后发生吻合口瘘1例、腹腔冲洗液细菌培养阳性2例。术后随访1年,吻合口狭窄1例,无严重并发症。结论选择性施行3D腹腔镜腹部无切口低位直肠前切除单吻合器结肛吻合术安全可行,具有临床运用价值,值得推广。

Objective To investigate the surgical technique,safety and clinical value of singlestapling anastomosis in 3D laparoscopy-assisted low anterior resection for rectal cancer without abdominal incision.Methods The clinical data of 120 patients with low rectal cancer which 3D laparoscopy-assisted low anterior resection with single-stapling anastomosis without abdominal incision were performed from Jan.2015 to Jan.2017 in the gastrointestinal surgery department of the east hospital affiliated to Tongji University were retrospectively analyzed and the techniques、safety and clinical value of the surgery approach were summarized.Results All patients were successfully performed the operation without conversion to open surgery.The operation time was(190.50±20.71)min,the intraoperative blood loss was(50.69±15.21)ml,the postoperative feeding time was(2.18±1.03)d,the postoperative hospital stay was(9.56±2.13)d,the postoperative distal and circumferential incised margins were negative,the postoperative anastomotic leakage was found in one patient and the bacterial culture of peritoneal washings were positive in two patients.The patients were followed up for one year,the anastomotic stenosis was found in one patient and no serious complications were found in other patients.Conclusions The selective applications of 3D laparoscopy-assisted low anterior resection with single-stapling anastomosis for rectal cancer without abdominal incision were safe and feasible.The surgery approach has clinical application value and is worthy of clinical promotion.