经远直肠段侧切口安置吻合器订座在腹腔镜中低位直肠癌根治术中的临床应用

目的探讨经肛门拖出切除并经远直肠段侧切口安置吻合器订座吻合在腹腔镜中低位直肠癌根治术中的临床应用价值,以寻求简单适用的吻合方式。方法回顾性分析贺州市人民医院2016年10月至2019年6月行腹腔镜中低位直肠癌根治术的60例患者的临床资料,根据手术方式分为腹腔镜下直肠癌前切除术组(对照组)30例和经肛门拖出式吻合术组30例(观察组);采用t检验比较2组患者手术时间、出血量、淋巴结清扫数目、胃肠功能恢复时间、住院时间及住院费用的差异;采用χ2检验比较2组患者术后并发症发生率的差异。结果2组患者性别、年龄、体质量指数、距肛缘距离、肿瘤直径以及肿瘤浸润深度方面比较,差异均无统计学意义(P均>0.05)。2组患者手术时间、出血量、淋巴结清扫数目、胃肠功能恢复时间和住院时间比较,差异均无统计学意义(P均>0.05);但是住院费用观察组低于对照组[(4.2±1.2)万元vs(5.3±2.5)万元],差异具有统计学意义(t=4.72,P=0.039)。观察组术后并发症发生率低于对照组[3.3%(1/30)vs 6.7%(2/30)],但组间差异无统计学意义(P>0.05)。结论简单易行的经肛门拖出式肿物切除并经远直肠侧切口安置吻合器订座吻合是一种新型吻合术式,可降低住院费用,治疗中低位直肠癌效果理想。

Clinical application of stapler placement via distal rectal incision in laparoscopic radical resection for middle-low rectal cancer

ObjectiveTo explore the clinical value of laparoscopic anastomat placement through a lateral incision of the distal rectal segment after anal pull-through resection in order to find a simple and applicable anastomosis method. MethodsClinical data of 60 patients who underwent radical surgery for laparoscopic middle and low rectal cancer at Hezhou People′s Hospital from October 2016 to June 2019 were retrospectively analyzed. According to the surgical method used, the patients were divided into either a control group (30 patients undergoing laparoscopic anterior resection of rectal cancer) or an observation group (30 patients undergoing anal pull-through anastomosis). The t-test was used to compare the differences in operation time, blood loss, number of lymph nodes dissected, time to gastrointestinal function recovery, hospitalization time, and hospitalization cost between the two groups. The chi-square test was used to compare the incidence of postoperative complications between the two groups. ResultsThere were no significant differences in gender, age, body mass index, distance from anal margin, tumor diameter, or tumor invasion depth between the two groups (P>0.05). Operation time, bleeding, number of lymph nodes dissected, time to gastrointestinal function recovery, and hospitalization time also had no significant difference between the two groups (P>0.05). However, the hospitalization cost was significantly lower in the observation group than in the control group [(4.2±1.2) million yuan vs (5.3±2.5) million yuan, t=4.72, P=0.039]. The incidence of postoperative complications in the observation group was lower than that of the control group [3.3% (1/30) vs 6.7% (2/30)], but there was no significant difference between them (P>0.05). ConclusionAnal pull-through resection of tumor and stapler placement through a distal rectal incision is a new, simple, and feasible anastomosis procedure, which can reduce the cost of hospitalization and has a satisfactory effect in the treatment of middle and low rectal cancer.