束带提拉法在腹腔镜辅助中低位直肠癌前切除术中的应用

目的:探讨束带提拉法(束带提拉直肠肠管)在腹腔镜辅助中低位直肠癌前切除术中的应用效果。方法:回顾性分析2016年4月—2017年4月在安徽医科大学附属省立医院普通外科行腹腔镜辅助中低位直肠癌前切除术(Dixon手术)的73例患者资料,其中束带提拉法下行腹腔镜辅助Dixon手术31例(提拉组),常规腹腔镜辅助Dixon手术42例(常规组)。分析比较两组患者相关临床指标。结果:两组患者术前一般资料具有可比性。与常规组比较,提拉组术中出血量、预防性末端回肠造瘘数、直肠充气试验阳性率、术后肛门排气时间、进食流质时间、术后住院时间、吻合口瘘与总并发症发生率、术后病理方面均无统计学差异(均P0.05),而其他方面,除手术时间延长(192 min vs.169 min)外,包括使用腹腔镜切割闭合器钉仓的中位数(1个vs.2个)、需要进行吻合口缝合加固比例(3.2%vs.19.0%)、一次性切割闭合肠管率(80.6%vs.28.6%)、医疗总费用(3.82万元vs.4.13万元)均有明显优势(均P0.05)。结论:束带提拉法是辅助腹腔镜辅助中低位直肠癌前切除术的有效手段。

Application of band lifting method in laparoscopy-assisted anterior resection for mid- and low-rectal cancer

Objective: To investigate the efficacy of using band lifting method (lifting the rectal canal with a band) in laparoscopy-assisted anterior resection for mid- and low-rectal cancer. Methods: The clinical data of 73 patients undergoing laparoscopy-assisted anterior resection for mid- and low-rectal cancer (Dixon surgery) from April 2016 to April 2017 in the Department of General Surgery of Anhui Provincial Hospital Affiliated to Anhui Medical University were retrospectively analyzed. Of the patients, 31 cases underwent laparoscopy- assisted Dixon surgery using band lifting method (bowel lifting group) and 42 cases underwent conventional laparoscopy- assisted Dixon surgery (conventional group). The main clinical variables between the two groups of patients were compared. Results: The preoperative data between the two groups of patients were comparable. In bowel lifting group compared with conventional group, no significant difference was found in terms of intraoperative blood loss, number of prophylactic ileostomy, positive rate of rectal balloon expulsion test, time to postoperative gas passage, time to postoperative liquid intake, length of postoperative hospital stay, incidence of anastomotic fistula and overall complications, and postoperative pathology (all P>0.05), while as for other aspects, except the prolonged operative time (192 min vs. 169 min), all the variables that included the median number of laparoscopic stapler cartridge used (1 vs. 2), proportion of anastomotic reinforcement requirement (3.2% vs. 19.0%), division and closure of the intestinal canal (80.6% vs. 28.6%) and medical cost (38 200 yuan vs. 41 300 yuan) were showed significant superiority (all P<0.05). Conclusion: Band lifting is an effective measure for assisting laparoscopy-assisted anterior resection for mid- and low-rectal cancer.