3D腹腔镜单吻合器法经肛门取出标本在超低位直肠癌保肛手术中的运用
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摘要
目的研究单吻合器法经肛门取出标本在超低位直肠癌保肛手术的临床疗效。方法回顾性分析2016年1月—2018年1月同济大学附属东方医院胃肠肛肠外科行腹腔镜直肠前切除术的112例超低位直肠癌患者临床资料。其中单吻合器法经肛门取标本手术83例,双吻合器法小切口手术29例,对比两组患者在手术时间、出血量、住院时间、初次造口排便时间、淋巴结检出数、下切缘长度、术后吻合口瘘发生率、肛门Wexner失禁评分以及1年无病生存率(disease-free survival,DFS)等方面的差异。结果全部112例手术顺利完成,两组患者在手术时间、出血量、淋巴结检出数、肛门Wexner失禁评分及1年DFS等方面差异无统计学意义(P>0. 05);单吻合器组住院天数少于双吻合器组,分别为(7. 9±3. 5) d和(10. 2±2. 5) d,差异有统计学意义(P<0. 01);两组初次造口排气时间分别为(13. 7±6. 0) h和(44. 6±5. 2) h,差异有统计学意义(P<0. 01);两组肿瘤下切缘长度分别为(1. 8±0. 3) cm和(1. 6±0. 2) cm,差异有统计学意义(P<0. 01);吻合口瘘发生率分别为2/83和4/29,差异有统计学意义(P<0. 01)。结论与传统双吻合器法相比,单吻合器法经肛门取出标本进行超低位直肠癌保肛安全可行,可缩短住院时间、促进术后恢复。
Objective To investigate the feasibility of 3 D-laparoscopic resection and transanal extraction of tumor using single stapling in anus-preserving surgery for patients with extra-low rectal cancer. Methods The clinical data of 112 patients with extra-low rectal cancer receiving laparoscopic anterior resection surgery in East Hospital,Tongji University from January 2016 to January 2018 were retrospectively analyzed. Among the 112 cases,83 cases underwent 3 D-laparoscopic resection and transanal extraction of tumor using single stapling and 29 cases underwent small incision resection with double stapling method. The operation time, volume of intraoperative blood loss, length of postoperative hospital stay,interval to first flatus,number of dissected lymph nodes,tumor resection margin length,postoperative anastomotic fistula,anal Wexner incontinence score and one-year disease-free survival rate were compared between the two groups. Results The operations were successfully completed in all 112 cases. There were no significant differences in operation time,volume of intraoperative blood loss,number of dissected lymph nodes,anal Wexner incontinence score and oneyear disease-free survival( all P>0. 05). The average length of postoperative hospital stay in the single stapling group was less than that in the double stapling group [( 7. 9±3. 5) d vs( 10. 2 ± 2. 5) d,P<0. 01]. The interval to first flatus in the two groups were( 13. 7 ± 6. 0) h and( 44. 6 ± 5. 2) h( P <0. 01). The tumor resection margin length int the two groups were( 1. 8±0. 3) cm and( 1. 6±0. 2) cm( P<0. 01). The postoperative anastomotic fistula rates were 2. 4%( 2/83) and 13. 8%( 4/29)( P<0. 05). Conclusion Compared with small incision resection with double stapling method,laparoscopic resection and transanal extraction of tumor using single stapling method in extra-low rectal cancer is safe and feasible,which can shorten length of hospitalization and promote postoperative recovery.
Objective To investigate the feasibility of 3 D-laparoscopic resection and transanal extraction of tumor using single stapling in anus-preserving surgery for patients with extra-low rectal cancer. Methods The clinical data of 112 patients with extra-low rectal cancer receiving laparoscopic anterior resection surgery in East Hospital,Tongji University from January 2016 to January 2018 were retrospectively analyzed. Among the 112 cases,83 cases underwent 3 D-laparoscopic resection and transanal extraction of tumor using single stapling and 29 cases underwent small incision resection with double stapling method. The operation time, volume of intraoperative blood loss, length of postoperative hospital stay,interval to first flatus,number of dissected lymph nodes,tumor resection margin length,postoperative anastomotic fistula,anal Wexner incontinence score and one-year disease-free survival rate were compared between the two groups. Results The operations were successfully completed in all 112 cases. There were no significant differences in operation time,volume of intraoperative blood loss,number of dissected lymph nodes,anal Wexner incontinence score and oneyear disease-free survival( all P>0. 05). The average length of postoperative hospital stay in the single stapling group was less than that in the double stapling group [( 7. 9±3. 5) d vs( 10. 2 ± 2. 5) d,P<0. 01]. The interval to first flatus in the two groups were( 13. 7 ± 6. 0) h and( 44. 6 ± 5. 2) h( P <0. 01). The tumor resection margin length int the two groups were( 1. 8±0. 3) cm and( 1. 6±0. 2) cm( P<0. 01). The postoperative anastomotic fistula rates were 2. 4%( 2/83) and 13. 8%( 4/29)( P<0. 05). Conclusion Compared with small incision resection with double stapling method,laparoscopic resection and transanal extraction of tumor using single stapling method in extra-low rectal cancer is safe and feasible,which can shorten length of hospitalization and promote postoperative recovery.
引文
[1]MARKS J H,SALEM J F,VALSDOTTIR E B,et al.Quality of life and functional outcome after transanal abdominal transanal proctectomy for low rectal cancer[J].Dis Colon Rectum,2017,60(3):258-265.
[2]RYU Y,AKAGI Y,YAGI M,et al.Fecoflowmetric analysis of anorectal motor function in postoperative anal-preserving surgery patients with low rectal cancer comparison with the wexner score and anorectal manometry[J].Int Surg,2015,100(1):29-37.
[3]傅传刚,周主青等.中高位直肠癌腹腔镜经直肠标本取出手术的保护措施[J].中华胃肠外科杂志,2017,20(10):56-60.
[4]陈春球,陈泓,朱春燕,等.腹腔镜辅助结直肠肿瘤经自然腔道标本取出手术疗效分析[J].同济大学学报(医学版),2019,40(1):55-60.
[5]MORELLI L,GUADAGNI S,DI FRANCO G,et al.Short-term clinical outcomes of robot-assisted intersphincteric resection and low rectal resection with doublestapling technique for cancer:a case-matched study[J].Int J Colorectal Dis,2016,31(3):737-739.
[6]KURAMOTO M,IKESHIMA S,YAMAMOTO K,et al.The intentional oblique transection double stapling technique in anterior resection for rectal cancer[J].Surg Today,2017,47(4):525-528.
[7]AKIYOSHI T,UENO M,FUKUNAGA Y,et al.Incidence of and risk factors for anastomotic leakage after laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique anastomosis for rectal cancer[J].Am J Surg,2011,202(3):259-264.
[8]TARGARONA E M,BALAGUE C,BERINDOAGUER,et al.Low section of the rectum during laparoscopic total mesorectal excision using the ContourTM device[J].Surg Endosc,2007,21(2):327-329.
[9]BUJKO K,RUTKOWSKI A,CHANG G J,et al.Is the 1 cm rule of distal bowel resection margin in rectal cancer based on clinical evidence?A systematic review[J].Ann Surg Oncol,2012,19(3):801-808.
[10]NELSON H,MACHAIRAS N,GROTHEY A.Evidence in favor of standard surgical treatment for rectal cancer[J].JAMA Oncol,2017,3(7):885.
[11]郑民华.腹腔镜低位超低位直肠癌保肛手术方式的选择[J].中华胃肠外科杂志,2007,10(4):311-313.
[2]RYU Y,AKAGI Y,YAGI M,et al.Fecoflowmetric analysis of anorectal motor function in postoperative anal-preserving surgery patients with low rectal cancer comparison with the wexner score and anorectal manometry[J].Int Surg,2015,100(1):29-37.
[3]傅传刚,周主青等.中高位直肠癌腹腔镜经直肠标本取出手术的保护措施[J].中华胃肠外科杂志,2017,20(10):56-60.
[4]陈春球,陈泓,朱春燕,等.腹腔镜辅助结直肠肿瘤经自然腔道标本取出手术疗效分析[J].同济大学学报(医学版),2019,40(1):55-60.
[5]MORELLI L,GUADAGNI S,DI FRANCO G,et al.Short-term clinical outcomes of robot-assisted intersphincteric resection and low rectal resection with doublestapling technique for cancer:a case-matched study[J].Int J Colorectal Dis,2016,31(3):737-739.
[6]KURAMOTO M,IKESHIMA S,YAMAMOTO K,et al.The intentional oblique transection double stapling technique in anterior resection for rectal cancer[J].Surg Today,2017,47(4):525-528.
[7]AKIYOSHI T,UENO M,FUKUNAGA Y,et al.Incidence of and risk factors for anastomotic leakage after laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique anastomosis for rectal cancer[J].Am J Surg,2011,202(3):259-264.
[8]TARGARONA E M,BALAGUE C,BERINDOAGUER,et al.Low section of the rectum during laparoscopic total mesorectal excision using the ContourTM device[J].Surg Endosc,2007,21(2):327-329.
[9]BUJKO K,RUTKOWSKI A,CHANG G J,et al.Is the 1 cm rule of distal bowel resection margin in rectal cancer based on clinical evidence?A systematic review[J].Ann Surg Oncol,2012,19(3):801-808.
[10]NELSON H,MACHAIRAS N,GROTHEY A.Evidence in favor of standard surgical treatment for rectal cancer[J].JAMA Oncol,2017,3(7):885.
[11]郑民华.腹腔镜低位超低位直肠癌保肛手术方式的选择[J].中华胃肠外科杂志,2007,10(4):311-313.