Luo Y, Yu M H, Chen J J, Qin J, Cui R, Huang Y Z, Zhong M
Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Mar 25;23(3):289-293. doi: 10.3760/cma.j.cn.441530-20190222-00044.
To compared the short-term surgical outcomes of the vertical supraumbilical incision with the left lower oblique incision for specimen retrieval in laparoscopic resection for rectal cancer. A retrospective cohort study was performed. Inclusion criteria: (1) rectal cancer confirmed by colonoscopy and pathological examination; (2) undergoing the operation for the first time; (3) laparoscopic rectal surgery performed by the same surgeon team; (4) age of > 18 years and < 76 years old. According to above criteria, clinical data of 178 consecutive patients scheduled for laparoscopic surgery for rectal cancer at Department of Gastrointestinal Surgery of Renji Hospital between March 2015 and December 2017 were collected. Based on incision site of the mini-laparotomy, patients were classified to the vertical supraumbilical incision group (n=75) and the left lower oblique incision group (=103). There were no significant differences in baseline data, such as age, gender, body mass index (BMI), tumor diameter, preoperative carcinoembryonic antigen (CEA) level, score of American Society of Anesthesiologists, TNM stage, between the two groups (all >0.05). Perioperative variables and follow-up data were compared between two groups. Between the vertical supraumbilical incision group and the left lower oblique incision group, the operation time [(131.7±3.7) minutes vs. (138.5±3.5) minutes], operative bleeding volume [(138.9±11.5) ml vs. (154.3±10.3) ml], length of auxiliary incision [(4.0±0.1) cm vs. (4.0±0.1) cm], and distance from anastomosis to dentate line [(3.8±0.1) cm vs. (4.2±0.1) cm] were not significantly different (all >0.05). As compared to the left lower oblique incision group, patients in vertical supraumbilical incision group had earlier flatus [(62.7±2.3) hours vs. (69.2±1.7) hours, =2.282, =0.023], earlier ambulation [(41.9±1.8) hours vs. (46.78±1.42) hours, =2.131, =0.032], lower pain VAS scores at postoperative 24 hours (2.0±0.1 vs. 2.4±0.1, 2.172, =0.032) and 48 hours (2.7±0.1 vs. 3.0±0.1, <0.05), and lower incidence of postoperative incisional hernia [6.7% (5/75) vs. 9.7% (10/103), χ(2)=3.942, =0.042]. However, the postoperative fluids intake time, hospitalization days, pain VAS scores at postoperative 12 hours and postoperative complications (wound infection, anastomotic leakage, urinary retention, intestinal obstruction) were not significantly different between the two groups (all >0.05). The vertical supraumbilical incision in laparoscopic resection for rectal cancer can reduce the degree of postoperative pain, facilitate early recovery of intestinal function and decrease the incidence of incisional hernia.
比较直肠癌腹腔镜切除术中经脐上垂直切口与左下腹斜切口取标本的短期手术效果。进行了一项回顾性队列研究。纳入标准：（1）经结肠镜检查及病理检查确诊为直肠癌；（2）首次接受手术；（3）由同一手术团队进行腹腔镜直肠手术；（4）年龄>18岁且<76岁。根据上述标准，收集了2015年3月至2017年12月在仁济医院胃肠外科连续178例行腹腔镜直肠癌手术患者的临床资料。根据小切口剖腹手术的切口部位，将患者分为脐上垂直切口组（n = 75）和左下腹斜切口组（n = 103）。两组患者的年龄、性别、体重指数（BMI）、肿瘤直径、术前癌胚抗原（CEA）水平、美国麻醉医师协会评分、TNM分期等基线资料比较，差异均无统计学意义（均>0.05）。比较两组患者的围手术期变量和随访数据。脐上垂直切口组与左下腹斜切口组比较，手术时间[（131.7±3.7）分钟 vs.（138.5±3.5）分钟]、术中出血量[（138.9±11.5）ml vs.（154.3±10.3）ml]、辅助切口长度[（4.0±0.1）cm vs.（4.0±0.1）cm]、吻合口至齿状线距离[（3.8±0.1）cm vs.（4.2±0.1）cm]差异均无统计学意义（均>0.05）。与左下腹斜切口组比较，脐上垂直切口组患者排气时间更早[（62.7±2.3）小时 vs.（69.2±1.7）小时，t = 2.282，P = 0.023]、下床活动时间更早[（41.9±1.8）小时 vs.（46.78±1.42）小时，t = 2.131，P = 0.032]，术后24小时（2.0±0.1 vs. 2.4±0.1，t = 2.172，P = 0.032）和48小时（2.7±0.1 vs. 3.0±0.1，P<0.05）疼痛视觉模拟评分（VAS）更低，术后切口疝发生率更低[6.7%（5/75） vs. 9.7%（10/103），χ² = 3.942, P = = 0.042]。然而，两组患者术后进流食时间、住院天数、术后第12小时疼痛VAS评分及术后并发症（伤口感染、吻合口漏、尿潴留、肠梗阻）比较，差异均无统计学意义（均>0.05）。直肠癌腹腔镜切除术中经脐上垂直切口可减轻术后疼痛程度，促进肠道功能早期恢复，降低切口疝发生率。
