Chen Shaoji, Wu Yunyun, Han Shanliang, Mo Qinliang, Ma Yuanming, Song Shiduo, Zhao Hong
Department of Surgery, The First People's Hospital of Wujiang District, Suzhou 215000, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2014 Dec;17(12):1216-9.
To explore a new procedure of laparoscopic dual anastomosis for mid-low rectal cancer to reduce postoperative complications.
Clinical data of 56 patients with mid-low rectal cancer undergoing laparoscopic rectal cancer resection(modified double-stapling technique, MDST, modification group) in the Department of General Surgery, the First Affiliated Hospital of Soochow University from February 2010 to June 2014 were compared with the data of 64 patients with mid-low rectal cancer (conventional double-stapling technique, DST, convention group) in the same period based on gender, age, tumor size, the distance from lower edge to the dentate line and tumor staging, etc. Patients in the modification group received operation as follows: (1) the rectum distal end was closed vertically instead of horizontally. (2) the anastomosis was conducted in an "end-corner" approach. (3) upper corner of the closed line in the distal end of rectum was removed. (4) the lower corner of closed line in the distal end of rectum was removed using vascular occlusion clamp method. (5) two T-shaped interchanges ("dangerous triangle") of stapled sutures formed after anastomosis were strengthened with absorbable suture. Patients in the convention group received laparoscopic dual anastomosis using conventional method: two corners and "dangerous triangles" were kept without any treatment. The clinical outcomes of two groups were analyzed retrospectively.
The intraoperational blood loss, postoperative drainage volume, postoperative anastomotic stoma bleeding, bowel function return and hospital stay were not significantly different between the two groups (all P>0.05). As compared to the convention group, the modification group had longer operation time [(211 ± 91) min vs. (174 ± 57) min, P<0.05], lower incidence of postoperative anastomotic leakage [1.8%(1/56) vs. 12.5% (8/64), P=0.030], lower tenesmus rate [3.6% (2/56) vs. 14.1% (9/64), P<0.05], less postoperative stoma re-creation [0 vs. 9.4% (6/64), P<0.05].
Modified laparoscopic dual anastomosis for mid-low rectal cancer can significantly reduce the incidence of post-surgical complications such as anastomotic leakage.
探索一种新的腹腔镜下中低位直肠癌双吻合术式，以减少术后并发症。
将苏州大学附属第一医院普外科2010年2月至2014年6月收治的56例接受腹腔镜直肠癌切除术（改良双吻合器技术，MDST，改良组）的中低位直肠癌患者的临床资料，与同期64例接受常规双吻合器技术（DST，传统组）的中低位直肠癌患者，基于性别、年龄、肿瘤大小、肿瘤下缘距齿状线距离及肿瘤分期等进行比较。改良组患者接受如下手术：（1）直肠远端垂直关闭而非水平关闭。（2）采用“端-角”吻合方式。（3）切除直肠远端关闭线的上角。（4）采用血管阻断钳法切除直肠远端关闭线的下角。（5）吻合后形成的两个T形吻合钉缝线交接处（“危险三角”）用可吸收缝线加固。传统组患者采用传统方法进行腹腔镜双吻合术：保留两个角及“危险三角”，未作任何处理。对两组患者的临床结局进行回顾性分析。
两组患者术中出血量、术后引流量、术后吻合口出血、肠功能恢复及住院时间比较，差异均无统计学意义（均P>0.05）。与传统组比较，改良组手术时间更长[（211±91）分钟对（174±57）分钟，P<0.05]，术后吻合口漏发生率更低[1.8%（1/56）对12.5%（8/64），P=0.030]，里急后重发生率更低[3.6%（2/56）对14.1%（9/64），P<0.05]，术后造口重建更少[0对9.4%（6/64），P<0.05]。
改良腹腔镜下中低位直肠癌双吻合术可显著降低吻合口漏等术后并发症的发生率。
