极低位直肠癌拖出式适形切除术中使用25号管状吻合器研究
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摘要
目的探讨极低位直肠癌(肿块下缘至齿线<2 cm)适形切除术中使用25号管状吻合器的安全性及对术后并发症及控便功能的影响。方法回顾性分析2011年1月至2016年11月海军军医大学附属长海医院收治的行直肠癌经肛拖出式适形切除术的52例极低位直肠癌病人的临床资料,术中均使用25号管状吻合器,并随访观察其术后并发症及控便功能情况。结果所有病人均顺利完成手术,无围手术期死亡病例。均行R0切除,肿块下缘至肛缘距离为3.4(3~4)cm,远切缘距离为0.5(0.3~1.0)cm,肿瘤直径为3.0(2.0~3.7)cm,术中失血量87.5(60~200)m L,手术时间为144.5(111~183)min,住院时间为12.0(9~14)d,术后住院时间为7.0(6~8)d,清扫淋巴结数为14.0(12.0~15.8)枚。随访33.0(21.0~52.5)个月。8例病人发生早期并发症,包括1例术后早期尿潴留、1例肺炎、1例吻合口漏、1例骶前感染、4例切口感染。9例病人发生远期并发症,包括1例肠梗阻、1例吻合口炎症、4例吻合口狭窄、1例直肠阴道瘘、2例腹股沟疝。造口还纳术后3~12个月,病人排便功能逐步恢复。2例病人分别在术后4、24个月发生了吻合口局部复发;5例远处转移全部发生在术后2年内。3年无进展存活率、总存活率分别为87.2%、98.0%。结论极低位直肠癌适形切除术中使用25号吻合器安全可靠,不增加吻合口漏与吻合口狭窄等并发症的发生,并且可以更好地保护排便功能。
Objective To investigate the effect of size 25 circular staplers in conformal sphincter preservation operation(CSPO) on postoperative complications and defecation function of very low rectal cancer. Methods The clinical data of 52 very low rectal cancer patients who accepted conformal sphincter preservation operation(size 25 circular staplers) in Department of Colorectal Surgery of Shanghai Changhai Hospital from January 2011 to November2016 were analyzed retrospectively. The postoperative complications and fecal function were recorded in the follow up.Results All the patients finished the operation successfully with R0 resection and no perioperative mortality. The distance from the lower edge of the tumor to the anal verge was 3.4(3-4)cm, the distal resection margin 0.5(0.3-1.0)cm,the tumor diameter3.0(2.0-3.7) cm, blood loss 87.5(60-200) m L, operation time 144.5(111.8-183.0) min, hospital stays12.0(9-14) days, postoperative hospital stays 7.0(6-8)d, and number of lymph nodes 14.0(12.0-15.8). The follow up time was 33.0(21.0-52.5)mon.8 patients developed early complications including one case of urinary retention, one case of pneumonia, one case of anastomotic leakage, one case of presacral infection and four cases of wound infection. Nine patients developed late complications, including one case of intestinal obstruction, one case of anastomotic inflammation,4 cases of anastomotic stenosis, one case of rectovaginal fistula and 2 cases of inguinal hernia. Three to 12 months afterthe ileostomy closure, the bowel function recovered gradually. Two patients underwent anastomotic recurrence in the 4 th and 24 th month after the surgery respectively; Five distant metastases all happened within2 years postoperatively. The 3-year PFS rateand OS rate were 87.2% and 98.0% respectively. Conclusion Size 25 circular staplers can be used safely and reliably in conformal sphincter preservation operation without increasing the incidence of anastomotic leakage and anastomotic stenosisas well as getting a better defecation function.
Objective To investigate the effect of size 25 circular staplers in conformal sphincter preservation operation(CSPO) on postoperative complications and defecation function of very low rectal cancer. Methods The clinical data of 52 very low rectal cancer patients who accepted conformal sphincter preservation operation(size 25 circular staplers) in Department of Colorectal Surgery of Shanghai Changhai Hospital from January 2011 to November2016 were analyzed retrospectively. The postoperative complications and fecal function were recorded in the follow up.Results All the patients finished the operation successfully with R0 resection and no perioperative mortality. The distance from the lower edge of the tumor to the anal verge was 3.4(3-4)cm, the distal resection margin 0.5(0.3-1.0)cm,the tumor diameter3.0(2.0-3.7) cm, blood loss 87.5(60-200) m L, operation time 144.5(111.8-183.0) min, hospital stays12.0(9-14) days, postoperative hospital stays 7.0(6-8)d, and number of lymph nodes 14.0(12.0-15.8). The follow up time was 33.0(21.0-52.5)mon.8 patients developed early complications including one case of urinary retention, one case of pneumonia, one case of anastomotic leakage, one case of presacral infection and four cases of wound infection. Nine patients developed late complications, including one case of intestinal obstruction, one case of anastomotic inflammation,4 cases of anastomotic stenosis, one case of rectovaginal fistula and 2 cases of inguinal hernia. Three to 12 months afterthe ileostomy closure, the bowel function recovered gradually. Two patients underwent anastomotic recurrence in the 4 th and 24 th month after the surgery respectively; Five distant metastases all happened within2 years postoperatively. The 3-year PFS rateand OS rate were 87.2% and 98.0% respectively. Conclusion Size 25 circular staplers can be used safely and reliably in conformal sphincter preservation operation without increasing the incidence of anastomotic leakage and anastomotic stenosisas well as getting a better defecation function.
引文
[1]Frascio M,Mandolfino F,Imperatore M,et al.The SECCA procedure for faecal incontinence:a review[J].Colorectal Dis,2014,16(3):167-172.
[2]Taflampas P,Christodoulakis M,Tsiftsis DD.Anastomotic leakage after low anterior resection for rectal cancer:Facts,obscurity,and fiction[J].Surg Today,2009,39(3):183-188.
[3]Makela JT,Kiviniemi H,Laitinen S.Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis[J].Dis Colon Rectum,2003,46(5):653-660.
[4]Peeters KC,Tollenaar RA,Marijnen CA,et al.Risk factors for anastomotic failure after total mesorectal excision of rectal cancer[J].Br J Surg,2005,92(2):211-216.
[5]Lee L.Risk factors for anastomotic leakage after resection for rectal cancer[J].Am J Surg,2009,198(3):461.
[6]Yang L,Huang XE,Zhou JN.Risk assessment on anastomotic leakage after rectal cancer surgery:an analysis of 753 patients[J].Asian Pac J Cancer Prev,2013,14(7):4447-4453.
[7]Lee S,Ahn B,Lee S.The Relationship between the number of intersections of staple lines and anastomotic leakage after the use of a double stapling technique in laparoscopic colorectal Surgery[J].Surg Laparosc Endosc Percutan Tech,2017,27(4):273-281.
[8]Qin Q,Ma T,Deng Y,et al.Impact of Preoperative tadiotherapy on anastomotic leakage and stenosis after rectal cancer resection:Post hoc analysis of a randomized controlled Trial[J].Dis Colon Rectum,2016,59(10):934-942.
[9]Petrin G,Ruol A,Battaglia G,et al.Anastomotic stenoses occurring after circular stapling in esophageal cancer surgery[J].Surg Endosc,2000,14(7):670-674.
[10]Yendamuri S,Gutierrez L,Oni A,et al.Does circular stapled esophagogastric anastomotic size affect the incidence of postoperative strictures?[J].J Surg Res,2011,165(1):1-4.
[11]Cong J,Dai X,Chen C,et al.Anal Sphincter Function after Intersphincteric Resection for Low Rectal Cancer[J].Chinese J Cancer Res,2007,19(4):295-298.
[12]Barisic G,Markovic V,Popovic M,et al.Function after intersphincteric resection for low rectal cancer and its influence on quality of life[J].Colorectal Dis,2011,13(6):638-643.
[13]Akagi Y,Kinugasa T,Shirouzu K.Intersphincteric resection for very low rectal cancer:a systematic review[J].Surg Today,2013,43(8):838-847.
[2]Taflampas P,Christodoulakis M,Tsiftsis DD.Anastomotic leakage after low anterior resection for rectal cancer:Facts,obscurity,and fiction[J].Surg Today,2009,39(3):183-188.
[3]Makela JT,Kiviniemi H,Laitinen S.Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis[J].Dis Colon Rectum,2003,46(5):653-660.
[4]Peeters KC,Tollenaar RA,Marijnen CA,et al.Risk factors for anastomotic failure after total mesorectal excision of rectal cancer[J].Br J Surg,2005,92(2):211-216.
[5]Lee L.Risk factors for anastomotic leakage after resection for rectal cancer[J].Am J Surg,2009,198(3):461.
[6]Yang L,Huang XE,Zhou JN.Risk assessment on anastomotic leakage after rectal cancer surgery:an analysis of 753 patients[J].Asian Pac J Cancer Prev,2013,14(7):4447-4453.
[7]Lee S,Ahn B,Lee S.The Relationship between the number of intersections of staple lines and anastomotic leakage after the use of a double stapling technique in laparoscopic colorectal Surgery[J].Surg Laparosc Endosc Percutan Tech,2017,27(4):273-281.
[8]Qin Q,Ma T,Deng Y,et al.Impact of Preoperative tadiotherapy on anastomotic leakage and stenosis after rectal cancer resection:Post hoc analysis of a randomized controlled Trial[J].Dis Colon Rectum,2016,59(10):934-942.
[9]Petrin G,Ruol A,Battaglia G,et al.Anastomotic stenoses occurring after circular stapling in esophageal cancer surgery[J].Surg Endosc,2000,14(7):670-674.
[10]Yendamuri S,Gutierrez L,Oni A,et al.Does circular stapled esophagogastric anastomotic size affect the incidence of postoperative strictures?[J].J Surg Res,2011,165(1):1-4.
[11]Cong J,Dai X,Chen C,et al.Anal Sphincter Function after Intersphincteric Resection for Low Rectal Cancer[J].Chinese J Cancer Res,2007,19(4):295-298.
[12]Barisic G,Markovic V,Popovic M,et al.Function after intersphincteric resection for low rectal cancer and its influence on quality of life[J].Colorectal Dis,2011,13(6):638-643.
[13]Akagi Y,Kinugasa T,Shirouzu K.Intersphincteric resection for very low rectal cancer:a systematic review[J].Surg Today,2013,43(8):838-847.