腹白线一针式预防性回肠双腔造口在腹腔镜直肠癌低位前切除术中的应用

探讨腹白线位置采用一针式进行预防性回肠双腔造口在腹腔镜直肠癌低位前切除术中的应用价值.回顾性分析2015年3月—2020年6月郓城县人民医院收治的53例低位的直肠癌保肛患者,自腹白线一针式预防性回肠双腔造口的腹腔镜直肠癌低位前切除术的28例(观察组),同期传统三层缝合式预防性回肠双腔造口的腹腔镜直肠癌低位前切除术25例...     

12 mm trocar在腹腔镜低位直肠癌根治术后预防性回肠造口中的应用北大核心CSCD

目的探讨12 mm trocar在腹腔镜低位直肠癌根治术后预防性回肠造口中的临床应用效果。方法回顾性分析2014年3月~2021年12月我院60例低位直肠癌的临床资料,2018年1月~2021年12月30例应用12 mm trocar行预防性回肠造口为观察组,2014年3月~2017年12月30例常规造口为对照组,观察2组患者造口手术时间、造口手术出血量、术后24 h造口处疼痛数字评分(Numeric Rating Scale,NRS)、造口相关并发症发生率、住院时间的差异。结果2组手术顺利,未发生严重并发症。观察组造口手术时间(19.5±3.8)min,显著短于对照组(25.7±5.8)min(t=-4.898,P=0.000);造口手术出血量(14.2±4.4)ml,明显少于对照组(18.7±5.6)ml(t=-3.461,P=0.001);术后24 h造口处疼痛NRS(2.2±1.0)分,明显低于对照组(3.2±1.0)分(t=-3.873,P=0.000)。2组造口相关并发症发生率分别为6.7%(2/30)、13.3%(4/30),差异无统计学意义(P=0.667);住院时间分别为(9.6±1.1)d、(9.7±1.0)d,差异无统计学意义(t=-0.368,P=0.714)。结论12 mm trocar应用在腹腔镜低位直肠癌根治术后预防性回肠造口中安全、可靠,值得临床推广应用。     

取标本切口行回肠造口在腹腔镜直肠前切除术中的应用

目的:探讨经取标本辅助切口行预防性回肠造口在腹腔镜直肠前切除术中的应用效果。方法:选取2020年4月至2022年4月收治的65例行腹腔镜直肠癌前切除+预防性回肠造口术的患者作为研究对象。根据造口位置分为观察组(经标本取出辅助切口行预防性回肠造口术,n=32)与对照组(另做切口行预防性造口术,n=33)。比较两组术中、术后及并发症发生情况。结果:两组均无吻合口漏发生,两组造口还纳手术时间、术中出血量、术后造口排气时间、术后进食时间、造口相关并发症、造口还纳切口感染发生率差异均无统计学意义(P>0.05)。观察组直肠癌前切除+预防性回肠造口术时间、术后24 h与48 h疼痛评分、术后住院时间均短于对照组(P<0.05)。结论:对于腹腔镜直肠癌前切除术后行预防性回肠造口的患者,经标本取出辅助切口取出标本并行预防性回肠造口是安全、可行的,值得临床应用。     

皮桥袢式回肠造口在腹腔镜低位直肠前切除术中应用价值研究

目的 探讨皮桥袢式回肠造口方法在腹腔镜低位直肠前切除术中的应用价值.方法 回顾性分析2015年1月至2019年6月在长江大学附属荆州医院结直肠肛门外科因低位直肠癌行腹腔镜低位直肠前切除术联合回肠造口80例病人资料.根据回肠造口方式不同分为皮桥袢式回肠造口组(40例)和传统袢式回肠造口组(40例).比较两组病人术后造口相...     

回肠管状造瘘术预防腹腔镜下低位/超低位直肠前切除术后吻合口瘘的临床观察(附15例报告)

目的:探讨应用回肠管状造瘘术预防腹腔镜下低位/超低位直肠前切除术后吻合口瘘的临床价值.方法:总结5年来应用回肠管状造瘘术预防腹腔镜下低位/超低位直肠前切除术后吻合口瘘的15例患者临床资料.手术操作方法为在腔镜下完成低位/超低位吻合后,充分游离回盲部,扩大主操作孔至3cm,拉出回盲部,切除阑尾,经其残端向未段回肠置入气囊导尿管,气囊内注水至肠壁稍发白,于水囊远侧缘以可吸收线穿回肠系膜打一结扣,抽出水囊内液体,回盲部回纳腹腔,按原注水量打入气囊,确保水囊位于线结扣近端,尿管截口引出,盲肠壁与侧腹壁固定.结果:全组无吻合口瘘发生,早期1例粪便转流不够彻底,其余患者粪便转流彻底,无肠梗阻发生,无切口感染及癌种植,拔管后无粪漏及腹膜炎发生,无死亡病例.结论:应用回肠管状造瘘术预防腹腔镜下低位/超低位直肠前切除术吻合口瘘是可行的,粪便转流是彻底的.     

预防性回肠造口对直肠前切除术后吻合口瘘及低位前切除综合征的影响分析

目的 探讨预防性回肠造口对直肠前切除术后吻合口瘘及低位前切除综合征(LARS)的影响。方法 收集2018年12月至2020年12月蚌埠医学院第一附属医院行腹腔镜下中低位直肠癌前切除手术的245例患者资料,根据是否一期行预防性回肠造口分为常规组(161例)及造口组(84例),比较两组吻合口瘘发生率、二次手术率、术后住院时间、住院费用及术后3、6、12个月时LARS评分的变化。结果 造口组吻合口瘘发生率显著低于常规组,差异有统计学意义(3.57%vs 12.42%,χ²=5.084,P=0.024);而两组二次手术率(0 vs 2.48%)、术后住院时间[(8.42±0.86) d vs (8.68±1.15) d]、平均住院费用[(5.42±0.36)万元vs(5.54±0.89)万元]差异无统计学意义。造口组术后3、6个月时的LARS评分分别为(25.5±2.4)分、(20.5±2.3)分,显著低于同期常规组的(34.3±4.1)分、(28.8±2.7)分,差异均有统计学意义(t=18.109、23.991,均P<0.001),但两组术后12个月时的LARS...     

腹腔镜直肠癌Dixon术两针式预防性回肠造口的方法和效果

目的探讨腹腔镜直肠癌Dixon术两针式预防性回肠造口的方法和效果。方法随机将接受腹腔镜直肠癌Dixon术的96例患者分为2组,各48例。A组采用传统预防性回肠造口,B组使用两针固定法行预防性回肠造口。比较两种造口的制作时间、造口相关并发症发生率,以及造口回纳术的用时。结果B组患者造口制作时间明显短于A组,差异有统计学意义(P<0.05)。2组术后并发症发生率及造口回纳术的用时差异无统计学意义(P>0.05)。结论腹腔镜直肠癌Dixon术中采取两针式预防性回肠造口,安全、简便。     

预防性横结肠造瘘对直肠低位前切除术吻合口瘘的影响

目的探讨预防性横结肠造瘘对直肠低位前切除术(LAR)吻合口瘘(AL)发生率的影响。方法回顾分析312例行直肠LAR的中下段直肠癌手术患者的临床资料,采用Fisher确切概率法对比分析行预防性横结肠造瘘对AL发生的影响。结果63例行预防性横结肠造瘘的直肠LAR发生AL有2例(3.2%),249例未行该造瘘的发生AL有21例(8.4%),两者无统计学差异(P0.05)。结论直肠LAR行预防性横结肠造瘘并不能有效地降低AL的发生率,且行预防性造瘘者,均需再次手术关瘘。     

选择性预防末端回肠造瘘在腹腔镜低位直肠癌保肛手术中的应用价值

目的:探讨选择性预防末端回肠造瘘在腹腔镜低位直肠癌保肛术中对降低吻合口漏发生率的临床价值。方法:回顾分析为109例患者行腹腔镜低位直肠癌保肛手术的临床资料,其中40例行预防性末端回肠造瘘术,69例未行末端回肠造瘘术,对比两组患者术后情况。结果:造瘘组术后无一例发生吻合漏,术后肛门排气时间平均(1.3±0.4)d,术后进食时间平均(1.8±0.4)d,术后盆腔引流管拔除时间平均(6.2±1.5)d,术后平均住院(8.0±1.5)d,治疗费用平均(3.2±0.3)万元。未造瘘组患者术后9例(13.0%)发生吻合口漏,术后肛门排气时间平均(5.1±0.6)d,术后进食时间平均(5.7±0.3)d,术后盆腔引流管拔除时间平均(8.3±3.8)d,术后平均住院(14.2±3.6)d;治疗费用平均(4.3±0.8)万元。两组术后观察指标差异均有统计学意义。结论:低位直肠癌保肛术中选择性预防末端回肠造瘘可有效降低吻合口漏的发生率,尤其高龄、全身情况较差等不利于低位吻合的患者。但术者应进行个体化选择,同时严格遵循无瘤原则、合理选择病例、精细操作可使更多的低位直肠癌患者获得保留肛门的机会。     

预防性回肠末端造口术对腹腔镜低位直肠癌根治性保肛手术疗效的影响

目的探讨预防性回肠末端造口术对腹腔镜低位直肠癌根治性保肛手术患者炎性指标与前白蛋白及肛门功能的影响。 方法选取2010年9月至2012年6月在徐州市肿瘤医院接受治疗的腹腔镜低位直肠癌根治性保肛手术患者96例,随机分为对照组（常规方式吻合）与观察组（预防性回肠末端造口）,各48例。比较两组患者围手术期指标,记录两组患者术后0.5~12个月肛门功能情况以及并发症,生存情况采用Kaplan-Meier法和Log-rank检验。 结果术后5 d时,观察组患者前白蛋白水平较术前及同期对照组水平升高,C反应蛋白（CRP）、白细胞计数（WBC）较术前及同期对照组水平降低,差异均有统计学意义（t=9.236、8.335、9.164,均P<0.05）。观察组患者的肛管静息压、肛管最大收缩压以及直肠最大耐受容量在术后6、9、12个月时均高于同期对照组,差异有统计学意义（均P<0.05）。观察组患者术后首次肛门排气时间、排便恢复时间、住院时间及并发症发生率均低于对照组,差异有统计学意义（t=6.323、5.913、6.135,χ²=7.529,均P<0.05）。两组5年生存率、无进展生存时间、平均生存时间比较,差异无统计学意义（χ²=0.349,t=2.475、1.616;P=0.560、0.450、0.329）。 结论预防性回肠末端造口术可降低腹腔镜低位直肠癌根治性保肛手术患者的炎性反应,明显改善患者肛门功能。     

Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer

Background With advanced stereoscopic vision, lack of tremor, and the ability to rotate the instruments surgeons find that robotic systems are ideal laparoscopic tools. Because of its high operating cost, however, robotic surgery should be reserved to procedures in which the technology can be of maximum benefit, usually when precise dissections in confined spaces are required. Because conventional laparoscopic total mesorectal excision is a challenging procedure, we have sought to assess the utility of the DaVinci robotic system in laparoscopic low anterior resections for cancer of the rectum. Methods Between November 2004 and May 2005 robotic-assisted low anterior resection with total mesorectal excision was performed on six consecutive patients with rectal cancer. These cases were compared with six consecutive low anterior resections performed with conventional laparoscopic techniques by the same surgeon. Results There were no conversions in either group. Operative and pathological data, complications, and hospital stay were similar in the two groups. Robotic operations appeared to cause less strain for the surgeon. Conclusions Robotic-assisted laparoscopic low anterior resection for rectal cancer is feasible in experienced hands. This technique may facilitate minimally invasive radical rectal surgery. Presented, in part, at the 14th International Congress of the Society of Laparoendoscopic Surgeons, September 14–17, 2005 San Diego, California.     

Results of laparoscopic anterior resection for rectal adenocarcinoma: retrospective analysis of 157 cases

BACKGROUND: Laparoscopic excision of rectal tumors has gained favor in the last decade and several issues have reported encouraging results: still, the use of laparoscopy remains open to debate. The aim of the current study is to assess the reliability of laparoscopic anterior resection (LAR) for rectal cancer analyzing short-term outcomes and long-term survival. METHODS: The charts of 157 patients were reviewed retrospectively after anterior resection for rectal adenocarcinoma performed by minimal access. Patients undergoing emergency surgery were excluded. LAR was excluded in presence of preoperative features at computed tomography (CT) scan suggesting bulky tumors unresectable by laparoscopy or in case of anesthesiologic contraindications. Conversion rate and functional and oncologic outcomes were analyzed. Data on long-term results and survival were evaluated. RESULTS: LAR was performed in 157 patients, and conversion to laparotomy was required in 12 cases. Mean operation time for nonconverted patients was 229 minutes (overall 238 minutes). Total mesorectal excision (TME) was performed in tumors of the mid and low rectum and a temporary ileostomy was performed in 56 patients. The mean length of hospital stay (LOS) was 10.5 days. Morbidity of anterior resection included 17 anastomotic leaks after laparoscopic surgery (LS; 5 in the converted patients). Conversion increased significantly the risk of leak (P < .005). Two leaks caused death. The mean number of nodes collected was 12. The incidence of local relapse was 4%, and the rate of anastomotic recurrence was nil. Survival probability with LS was .73 at 5 years. Patients in stage III took advantage of adjuvant treatment and had a better survival than patients in stage II (P = not significant [NS]). CONCLUSIONS: The outcomes of this study suggest that LAR for rectal cancer is a reliable procedure. Oncologic requirements were respected; parameters such as length of specimen, distal margin, and number of nodes retrieved were quite acceptable. Incidences of local recurrence and long-term survival were comparable with those of other series.     

腹腔镜低位直肠前切除术后吻合口漏的原因及预防

【摘要】 目的 探讨腹腔镜下低位直肠前切除术后吻合口漏的原因和预防措施。方法 回顾性分析2014年5月至2015年6月253例低位直肠癌患者行腹腔镜低位直肠前切除术的临床资料。结果 253例患者手术均获成功,无一例死亡。其中15例患者(5.9%)发生了术后吻合口漏,1例因腹膜炎行腹腔镜再手术并行回肠末端造口,14例经腹膜外骶前引流、局部冲洗、抗感染及肠外营养支持等保守治疗后痊愈;其余患者恢复良好。腹腔镜低位直肠前切除术发生术后吻合口漏的原因主要与术后肠管血运不良、吻合口张力较大以及直肠双吻合技术缺陷有关。结论 腹膜外骶前置管引流是是治疗术后吻合口漏的有效措施。     

腹腔镜直肠癌手术的研究现状

通过复习近年国际上针对腹腔镜和机器人辅助腹腔镜直肠癌手术的文献报道,特别是中低位直肠癌手术的随机和非对随机对照试验,讨论当前腹腔镜直肠癌手术的研究现状。虽然腹腔镜直肠癌根治术已被证实安全可行,且与传统开腹手术有相同的肿瘤学疗效,但目前为止,关于腹腔镜直肠癌手术的多中心随机对照研究有限。当前,开腹手术仍是直肠癌外科治疗的标准术式。近年来。机器人手术在其他外科领域被成功应用,但在直肠癌手术中正处于探究阶段。     

腹腔镜下低位直肠癌前切除术

本手术为腹腔镜下低位直肠癌前切除术式,同时使用吲哚菁绿染色免疫荧光技术。手术视频总长30 min,视频全程无剪辑无加速,基本能反映出手术全程步骤的各个细节,全程手术层次入路标准,几乎无出血。腔镜下操作及缝合动作流畅,手术流程亮点包括保留左结肠动脉、吲哚菁绿染色荧光以及减张关闭盆底腹膜。     

Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loop colostomy after low anterior resection for rectal carcinoma

Introduction

Defunctioning loop ileostomy (LI) and loop colostomy (LC) are used widely to protect/treat anastomotic leakage after colorectal surgery. However, it is not known which surgical approach has a lower prevalence of surgical complications after low anterior resection for rectal carcinoma (LARRC).

Methods

We conducted a literature search of PubMed, MEDLINE, Ovid, Embase and Cochrane databases to identify studies published between 1966 and 2013 focusing on elective surgical complications related to defunctioning LI and LC undertaken to protect a distal rectal anastomosis after LARRC.

Results

Five studies (two randomized controlled trials, one prospective non-randomized trial, and two retrospective trials) satisfied the inclusion criteria. Outcomes of 1,025 patients (652 LI and 373 LC) were analyzed. After the construction of a LI or LC, there was a significantly lower prevalence of sepsis (p=0.04), prolapse (p=0.03), and parastomal hernia (p=0.02) in LI patients than in LC patients. Also, the prevalence of overall complications was significantly lower in those who received LIs compared with those who received LCs (p<0.0001). After closure of defunctioning loops, there were significantly fewer wound infections (p=0.006) and incisional hernias (p=0.007) in LI patients than in LC patients, but there was no significant difference between the two groups in terms of overall complications.

Conclusions

The results of this meta-analysis show that a defunctioning LI may be superior to LC with respect to a lower prevalence of surgical complications after LARRC.