膜间隙入路双隧道法在腹腔镜低位直肠癌手术当中的临床应用价值

摘要/Abstract

摘要： 目的探究膜间隙入路双隧道法在腹腔镜低位直肠癌手术中的应用价值。方法回顾性选择2020年1月~2021年4月宁夏医科大学总医院接受腹腔镜手术治疗的60例低位直肠癌患者为研究对象,按照其接受术式的差异分为研究组（30例,接受膜间隙入路双隧道法）与对照组（30例,接受常规腹腔镜根治术）,对比两组患者一般手术资料（手术时间、术中出血量、住院时间、术后通气时间）、术后指标（吻合口瘘、吻合口狭窄、腹腔出血、切口感染发生率）、盆腔神经保护效果（术后1个月、3个月和6个月时性功能、排尿功能得分及肛门括约肌控便能力）以及远期并发症（吻合口出血、腹腔出血、预防性造瘘手术造口、深静脉血栓、肺栓塞发生率）的差异。结果研究组患者的手术时间和术中出血量高于对照组,但住院时间及术后通气时间低于对照组,差异有统计学意义（P<0.05）;术后研究组发生吻合口瘘1例,吻合口狭窄1例,切口感染1例,对照组发生吻合口瘘2例,腹腔出血1例,切口感染2例,两组术后指标方面差异无统计学意义（P>0.05）;术后1个月、3个月及6个月时,研究组患者的排尿功能得分均显著低于对照组,性功能得分均显著高于对照组,研究组术后3个月及6个月时控便能力均显著优于对照组,差异有统计学意义（P<0.05）,术后3个月及6个月时,两组排尿功能得分、性功能得分低于术后1个月,控便能力均显著优于术后1个月,差异有统计学意义（P<0.05）;两组患者术后均无深静脉血栓以及肺栓塞的出现,随访1年显示无局部复发以及远处转移,以及死亡病例出现。结论膜间隙入路双隧道法在腹腔镜低位直肠癌手术中具有较好的应用价值,能明显改善患者术后排尿功能、性功能及排便控制能力,且手术安全性较高。

关键词: 膜间隙入路, 双隧道法, 腹腔镜, 低位直肠癌, 临床价值

Abstract: Objective To explore the value of double tunnel approach through membranous space in laparoscopic surgery for low rectal cancer. Methods A retrospective study of 60 patients with low rectal cancer who underwent laparoscopic surgery in Ningxia Medical University General Hospital from January 2020 to April 2021 were selected as the research subjects. According to the differences of operation methods, they were divided into the study group (n=30, double tunnel method through membranous space approach) and the control group (n=30, conventional laparoscopic radical surgery). The general operation data of the two groups (operation time, intraoperative bleeding, hospital stay, postoperative ventilation time) were compared Postoperative indexes (anastomotic leakage, anastomotic stenosis,celiac hemorrhage, incidence of incision infection), pelvic neuroprotective effect (sexual function, micturition function score and anal sphincter defecation control ability at 1, 3 and 6 months after operation) and long-term follow-up (anastomotic bleeding, abdominal bleeding, prophylactic fistula, deep venous thrombosis and pulmonary embolism). Results The operation time and intraoperative blood output of the study group were higher than those of the control group, but the hospital stay and postoperative ventilation time were lower than those of the control group. The difference between the groups was statistically significant (P<0.05); there were 1 case of anastomotic leakage, 1 case of anastomotic stenosis and 1 case of incision infection in the study group, 2 cases of anastomotic leakage, 1 case of abdominal bleeding and 2 cases of incision infection in the control group. There was no significant difference in postoperative indexes between the two groups (P>0.05); at 1 month, 3 months and 6 months after operation, the urinary function scores of the patients in the study group were significantly lower than those in the control group, and the sexual function scores were significantly higher than those in the control group. The stool control ability scores were significantly higher than those in the control group, and the difference between the two groups was statistically significant (P<0.05). At 3 months and 6 months after operation, the scores of urination function and sexual function in the two groups were lower than that of one month before operation, and the defecation control ability was significantly higher than that of one month after operation, and the difference between groups was statistically significant (P<0.05); there were no deep venous thrombosis and pulmonary embolism in both groups after operation. The follow-up for 1 year showed no local recurrence, distant metastasis and death. Conclusion Intermembrane approach double tunnel method has good application value in laparoscopic low rectal cancer surgery, can significantly improve postoperative urinary function, sexual function and defecation control ability, and the operation is safe.

Key words: interstitial approach, double tunnel method, laparoscopy, low rectal cancer, clinical value

中图分类号:

R735.37

赵少辉, 马硕, 苏进达, 何亚琴, 谢小亮. 膜间隙入路双隧道法在腹腔镜低位直肠癌手术当中的临床应用价值[J]. 中华养生保健, 2022, 40(24): 59-62.

ZHAO Shao-hui, MA Shuo, SU Jin-da, HE Ya-qin, XIE Xiao-liang. Clinical Application of Double-Tunnel Approach Through Intramembranous Approach in Laparoscopic Low Rectal Cancer Surgery[J]. ZHONGHUA YANGSHENG BAOJIAN, 2022, 40(24): 59-62.

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