Su H, Bao M D L, Wang P, Wang X W, Nie H X, Yun H, Liang J W, Liu Q, Wang X S, Zhou Z X, Zhou H T
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China.
Zhonghua Zhong Liu Za Zhi. 2019 Jul 23;41(7):553-557. doi: 10.3760/cma.j.issn.0253-3766.2019.07.014.
To explore the clinical safety and feasibility of enterostomy using running suture of dermis and seromuscular layer in laparoscopic-assisted radical resection for rectal carcinoma. From May 1, 2017 to May 1, 2018, 46 patients who underwent laparoscopic-assisted radical resection for rectal carcinoma with enterostomy using running suture of dermis and seromuscular layer in Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively enrolled in this study. Data regarding clinicopathologic characteristics, operation and postoperative outcomes, stoma-related complications and functions of stoma were collected and analyzed. All of the 46 patients successfully underwent this operation. Among them, 30 patients underwent laparoscopic-assisted abdominoperineal resection for rectal cancer with sigmoidostomy and 16 patients underwent laparoscopic-assisted low anterior resection for rectal cancer with loop ileostomy. The mean operation time was 115.3 minutes and intraoperative blood loss was 86.1 ml. The mean time for enterostomy was 14.1 minutes. The average time to flatus, time to fluid diet intake and length of hospital stay were 1.8 days, 2.9 days and 6.5 days, respectively. During the follow-up period, three patients suffered from stomal edema, two patients suffered from parastomal hernia, and two patients suffered from skin inflammation surrounding stoma. None of re-operation related stoma and severe mobility such as stomal stenosis, stomal necrosis, stomal prolapse, stomal retraction and stomal mucocutaneous separation occurred. Thirty-five patients recovered with satisfactory stomal function, two with middle function and one with poor function. Enterostomy using running suture of dermis and seromuscular layer in laparoscopic-assisted radical resection for rectal carcinoma is a safe and feasible procedure with a satisfactory short-term effect.
探讨在腹腔镜辅助直肠癌根治术中采用真皮和浆肌层连续缝合行肠造口术的临床安全性及可行性。回顾性纳入2017年5月1日至2018年5月1日在中国医学科学院肿瘤医院行腹腔镜辅助直肠癌根治术并采用真皮和浆肌层连续缝合行肠造口术的46例患者。收集并分析患者的临床病理特征、手术及术后结果、造口相关并发症及造口功能等数据。46例患者均成功完成手术。其中,30例行腹腔镜辅助直肠癌腹会阴联合切除术并乙状结肠造口术,16例行腹腔镜辅助直肠癌低位前切除术并回肠袢式造口术。平均手术时间为115.3分钟,术中出血量为86.1毫升。平均肠造口时间为14.1分钟。平均排气时间、开始流食时间及住院时间分别为1.8天、2.9天和6.5天。随访期间,3例患者发生造口水肿,2例患者发生造口旁疝,2例患者发生造口周围皮肤炎症。未发生与再次手术相关的造口及严重移位情况,如造口狭窄、造口坏死、造口脱垂、造口回缩及造口黏膜皮肤分离。35例患者造口功能恢复满意,2例功能中等,1例功能差。在腹腔镜辅助直肠癌根治术中采用真皮和浆肌层连续缝合行肠造口术是一种安全可行的手术方法,短期效果良好。