School of Medicine, Nankai University, Tianjin 300071, China.
Department of General Surgery, Tianjin Union Medical Center, Tianjin 300121, China.
Chin Med J (Engl). 2018 Feb 5;131(3):289-294. doi: 10.4103/0366-6999.223852.
Pelvic floor peritoneum reconstruction is a key step in various standard resections for open radical rectal cancer. However, during endoscopic surgery, most surgeons do not close the pelvic floor peritoneum. This study aims to evaluate the efficacy of pelvic peritonization during laparoscopic Dixon surgery using an observational study.
A total of 189 patients, who underwent laparoscopic Dixon surgery at Tianjin Union Medical Center, China, were analyzed retrospectively. All of the cases were divided into two groups according to the differences of surgical procedure. The 92 patients in Group A (observation group) underwent pelvic peritonization and the 97 patients in Group B (control group) did not undergo this procedure. Postoperative complications were observed in the two groups, compared, and analyzed using the Chi-square or Fisher's exact test.
The incidence of anastomotic leakage was significantly lower in Group A than in Group B (P = 0.014). A significant difference was found in the postoperative short-term (P = 0.029) and long-term (P = 0.029) ileus rates between the two groups, with Group A exhibiting a lower rate than Group B. Patients in Group A had significantly lower rates of postoperative infections than those in Group B (χ2 = 7.606, P = 0.006; χ2 = 4.464, P = 0.035). Patients in Group A had significantly lower rates of deep venous thrombosis than those in Group B (χ2 = 8.531, P = 0.003).
Pelvic peritonization effectively reduces postoperative complications, such as anastomotic leakage, which warrants its increased use in laparoscopic surgery.
盆腔腹膜重建是开腹根治性直肠癌各种标准切除术的关键步骤。然而,在进行内镜手术时,大多数外科医生并不关闭盆底腹膜。本研究旨在通过观察性研究评估腹腔镜 Dixon 手术中进行盆腹膜化的疗效。
回顾性分析了在中国天津医科大学总医院接受腹腔镜 Dixon 手术的 189 例患者。所有病例均根据手术方式的不同分为两组。A 组(观察组)92 例行盆腔腹膜化,B 组(对照组)97 例未行该操作。观察两组术后并发症并进行比较分析,采用卡方检验或 Fisher 确切概率法。
观察组吻合口漏发生率明显低于对照组(P = 0.014)。两组术后短期(P = 0.029)和长期(P = 0.029)肠梗阻发生率存在显著差异,观察组发生率低于对照组。观察组术后感染发生率明显低于对照组(χ2 = 7.606,P = 0.006;χ2 = 4.464,P = 0.035)。观察组术后深静脉血栓发生率明显低于对照组(χ2 = 8.531,P = 0.003)。
盆腔腹膜化可有效减少吻合口漏等术后并发症,值得在腹腔镜手术中更多地应用。