Han Y, Zhi Q M, Kuang Y T, Pan Y
General Surgery Department, the First Affiliated Hospital of Soochow University,Suzhou 215006,China.
Zhonghua Yi Xue Za Zhi. 2023 Feb 14;103(6):425-430. doi: 10.3760/cma.j.cn112137-20221129-02528.
To investigate the effect of pelvic peritoneum reconstruction on the prognosis of patients underwent laparoscopic low anterior resection of rectal adenocarcinoma. This retrospective cohort study included 97 patients who underwent laparoscopic low anterior resection of rectal adenocarcinoma in General Surgery Department, the First Affiliated Hospital of Soochow University from January 2017 to June 2021. According to the implementation of pelvic peritoneum reconstruction, the subjects were divided into study group (48 patients underwent pelvic peritoneum reconstruction after laparoscopic resection) and control group (49 patients not underwent pelvic peritoneum reconstruction). The two groups were compared in terms of Wexner score of anal function, anorectal manometry results, normal rate of defecation sensation, pelvic floor anatomical structure and postoperative complications. Five-year survival analysis was performed. Patients in the study group and the control group were (61.25±10.38) years old and (59.47±11.40) years old (>0.05). The proportions of male patients were 60.4% (29 cases) and 55.1% (27 cases) (>0.05) in the study group and control group, respectively. At 3, 6 and 12 months after surgery, Wexner scores of anal function in the study group were lower than those in the control group [(14.29±2.07) vs (16.33±2.18), <0.001; (9.57±2.34) vs (11.26±2.85), =0.002; (5.41±1.36) vs (7.86±1.95), <0.001, respectively]. The anal resting pressure and anal systolic pressure of the study group were higher than those of the control group [(56.29±7.31) mmHg vs (52.88±6.65) mmHg, =0.018; (129.33±17.36) mmHg vs (110.45±15.22) mmHg, <0.001, respectively] (1 mmHg=0.133 kPa). The rectal sensory volume, rectal maximum tolerance volume, and the length of anal high-pressure area in the study group were greater than those in the control group [(32.15±4.38) vs (29.76±4.29), =0.008; (209.57±40.27) vs (184.39±37.56), =0.002; (3.07±0.52) vs (2.80±0.49), =0.010, respectively]. At 3 and 6 months after surgery, the normal rates of defecation sensation in the study group were 47.9% (23 cases) and 70.8% (34 cases), respectively, higher than those in the control group [26.5% (13 cases) and 51.0% (25 cases)] (=0.029 and 0.046, respectively). The detection rate of intestinal tube accumulation in the study group was lower than that in the control group [12.5% (6 cases) vs 38.9% (19 cases)] (=0.003). There was no significant difference in the total incidence of complications (anastomotic leakage, abdominal infection, intestinal obstruction, pendant pneumonia and urinary tract infection) between the two groups [18.8% (9 cases) vs 24.5% (12 cases)] (=0.493). There was no significant difference in 5-year cumulative survival rate between the study group and the control group (71.6% vs 68.2%, =0.309). Pelvic peritoneum reconstruction can improve postoperative anal function and reduce intestinal tube accumulation in patients underwent laparoscopic low anterior resection of rectal adenocarcinoma with high safety and feasibility.
探讨盆腔腹膜重建对腹腔镜下直肠腺癌低位前切除术患者预后的影响。本回顾性队列研究纳入了2017年1月至2021年6月在苏州大学附属第一医院普通外科接受腹腔镜下直肠腺癌低位前切除术的97例患者。根据盆腔腹膜重建的实施情况，将研究对象分为研究组（48例患者在腹腔镜切除术后进行盆腔腹膜重建）和对照组（49例患者未进行盆腔腹膜重建）。比较两组患者的肛门功能Wexner评分、肛肠测压结果、排便感觉正常率、盆底解剖结构及术后并发症。进行了五年生存率分析。研究组和对照组患者的年龄分别为（61.25±10.38）岁和（59.47±11.40）岁（>0.05）。研究组和对照组男性患者的比例分别为60.4%（29例）和55.1%（27例）（>0.05）。术后3、6和12个月，研究组的肛门功能Wexner评分低于对照组[（14.29±2.07）对（16.33±2.18），<0.001；（9.57±2.34）对（11.26±2.85），=0.002；（5.41±1.36）对（7.86±1.95），分别为<0.001]。研究组的肛门静息压和肛门收缩压高于对照组[（56.29±7.31）mmHg对（52.88±6.65）mmHg，=0.018；（129.33±17.36）mmHg对（110.45±15.22）mmHg，<0.001，分别为]（1 mmHg = 0.133 kPa）。研究组的直肠感觉容量、直肠最大耐受容量和肛门高压区长度均大于对照组[（32.15±4.38）对（29.76±4.29），=0.008；（209.57±40.27）对（184.39±37.56），=0.002；（3.07±0.52）对（2.80±0.49），=0.010，分别为]。术后3个月和6个月，研究组排便感觉正常率分别为47.9%（23例）和70.8%（34例），高于对照组[26.5%（13例）和51.0%（25例）]（分别为=0.029和0.046）。研究组肠管积气的检出率低于对照组[12.5%（6例）对38.9%（19例）]（=0.003）。两组并发症（吻合口漏、腹腔感染、肠梗阻、坠积性肺炎和尿路感染）的总发生率无显著差异[18.8%（9例）对24.5%（12例）]（=0.493）。研究组和对照组的五年累积生存率无显著差异（71.6%对68.2%，=0.309）。盆腔腹膜重建可改善腹腔镜下直肠腺癌低位前切除术患者的术后肛门功能，减少肠管积气，安全性和可行性高。
