摘要
目的 探讨延长右下腹主操作孔取标本并行预防性回肠造口在腹腔镜直肠癌前切除术中的安全性、可行性.方法 回顾性分析2021 年4 月～2024 年4 月同一术者在上海交通大学医学院附属瑞金医院、浙江定海医院(上海瑞金医院舟山分院)130 例腹腔镜直肠癌前切除联合预防性回肠造口的临床资料,术中乙状结肠游离度好、系膜无明显水肿者延长右下腹主操作孔取标本并行造口(观察组,n=56),游离度不够、结肠短、系膜水肿者选取经左绕脐辅助切口取出标本,右下腹主操作孔行回肠造口(对照组,n=74).比较2 组术中、术后指标及造口相关并发症. 结果 2 组均顺利完成手术.与对照组相比,观察组手术时间短[(133.6±7.1)min vs. (136.2±7.3)min,t=-1.972,P=0.005],术后24 h、48 h 疼痛评分低[(2.6±1.1)分vs. (2.9±1.3)分,t=-1.711,P=0.017;(1.5±0.6)分vs. (1.6±0.6)分,t=-1.437,P=0.042],术后住院时间短[(6.9±1.2)d vs. (7.2±1.3)d,t=-1.411,P=0.045].2 组术中出血量、造口排气时间、进流食时间、并发症发生率差异无显著性(P>0.05). 结论 对于中低位直肠癌行腹腔镜直肠癌前切除联合预防性回肠造口术,术中乙状结肠游离度好、系膜无明显水肿者延长右下腹主操作孔取标本并行回肠造口是安全、可行的,符合快速康复外科理念.
Abstract
Objective To discuss the safety and feasibility of extending the main operating port in the right lower abdomen for specimen collection while performing preventive ileostomy during laparoscopic anterior resection of rectal cancer.Methods A retrospective analysis of clinical data of 130 cases of laparoscopic anterior resection of rectal cancer combined with preventive ileostomy performed by the same surgeon from April 2021 to April 2024 was carried out.For patients with good mobility of the sigmoid colon and no significant edema of the mesentery,the main operating port in the right lower abdomen was extended to obtain specimens and perform ileostomy ( observation group,n=56 ).For those with insufficient mobility,short colon,and mesenteric edema,specimens were obtained through an auxiliary incision around the left of the umbilicus,and ileostomy was performed at the main operating port in the right lower abdomen (control group,n=74).The intraoperative indicators,postoperative indicators,and stoma-related complications of the two groups were compared.Results Both groups successfully completed the surgery.Compared to the control group,the observation group had a shorter surgery time[(133.6±7.1) min vs.(136.2±7.3) min,t=-1.972,P=0.005],lower pain scores at 24 h and 48 h postoperatively[(2.6±1.1) points vs.(2.9±1.3) points,t=-1.711,P=0.017;(1.5±0.6) points vs.(1.6±0.6) points,t=-1.437,P=0.042],and a shorter hospital stay postoperatively[(6.9±1.2) d vs.(7.2±1.3) d,t=-1.411,P=0.045].There were no significant differences in intraoperative blood loss,time to colostomy gas passage,time to start a liquid diet,and incidence of complications between the two groups (P>0.05).Conclusion For laparoscopic anterior resection combined with preventive ileostomy for low-to-mid rectal cancer,extending the main operating port in the right lower abdomen to obtain specimens and performing ileostomy is safe and feasible when there are good mobilization of the sigmoid colon and no significant edema of the mesentery,aligning with the principles of enhanced recovery after surgery.
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