摘要/Abstract

摘要： 目的·研究腹腔镜直肠双吻合术吻合口不同加固方式对吻合口漏的影响。方法·收集2017年7月—2018年9月上海交通大学医学院附属瑞金医院胃肠外科（上海市微创外科临床医学中心）收治的接受腹腔镜下直肠双吻合术的患者资料，根据吻合口加固方式的不同分为间断缝合加固组（n=41）、连续缝合加固组（n=41）、不加固组（对照组，n=42），比较3组术中和术后的情况。采用单因素方差分析、χ2检验或Fisher's精确概率法、非参数检验进行统计学分析。结果·共纳入124例患者，间断缝合加固组、连续缝合加固组的手术时间、术中失血量、术后住院天数、术后胃肠道排气时间、术后进食流质时间等指标与对照组比较，差异无统计学意义。9例被诊断为吻合口漏。间断缝合加固组、连续缝合加固组的严重吻合口漏发生率较对照组低。间断缝合加固组吻合口漏患者的平均住院天数为31（19～42）d，连续缝合加固组为41（37～43）d，均低于对照组的64（54～74）d。间断缝合加固组的平均治疗费用为（71 142.6±2 849.3）元，连续缝合加固组为（71 360.1±2 072.3）元，均少于对照组的（91 386.0±9 151.7）元。结论·腹腔镜直肠双吻合术后，应用间断缝合法和连续缝合法加固吻合口能够降低严重吻合口漏发生率、缩短住院时间、降低治疗费用，未增加手术时间及术后并发症风险。
关键词: 吻合口漏, 直肠癌, 双吻合技术, 加固缝合, 腹腔镜手术
Abstract:
Objective · To investigate the effect of different suture reinforcement methods on anastomotic leakage (AL) after laparoscopic double stapled technique (DST). Methods · Data were collected from patients undergoing laparoscopic radical resection of colon-rectal cancer from July 2017 to September 2018 in the Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai Minimally Invasive Surgery Center). Patients were divided into 3 groups according to the different ways of suture reinforcement: intermittent suture reinforcement group (n=41), continuous suture reinforcement group (n=41) and non-reinforcement group (control group, n=41). The intraoperative and postoperative conditions of the three groups were compared. One-way ANOVA, χ2 test, Fisher's test and non-parametric test were used for statistical analysis. Results · A total of 124 patients were included in this study. There were no statistically significant differences in operation time, intraoperative blood loss, postoperative hospital stay, postoperative gastrointestinal exhaust time and postoperative fluid intake time of two experimental groups compared with control group. Nine subjects were clinically diagnosed with anastomotic leakage. The incidences of serious AL of intermittent suture reinforcement group and continuous suture reinforcement group were lower than that in the control group. The average length of stay in patients with AL in the intermittent suture reinforcement group was 31 (19-42) d, and the continuous suture reinforcement group was 41 (37-43) d, which were significantly lower when compared with the control group of 64 (54-74) d. In addition, the average treatment cost of the intermittent suture reinforcement group was (71 142.6±2 849.3) yuan, and the continuous suture reinforcement group was (71 360.1±2 072.3) yuan, which were significantly lower than the control group of (91 386.0±9 151.7) yuan. Conclusion · Laparoscopic DST using intermittent suture and continuous suture can reduce the incidence of serious AL, shorten the length of hospital stay and reduce the cost of treatment without increasing the difficulty of surgery and other postoperative complications.
Key words: anastomotic leakage, rectal cancer, double stapled technique, reinforcement suture, laparoscopic surgery


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