经直肠标本取出式3D腹腔镜低位直肠癌前切除术远切端两种处理方式对比研究

目的探讨直肠癌经肛门直肠标本取出式3D腹腔镜低位直肠前切除术远切端两种处理方式对临床结果的影响。 方法回顾性分析同济大学附属东方医院2016年1月至2018年3月接受经直肠标本取出式3D腹腔镜低位直肠癌前切除术患者40例的临床资料，按照远切端处理不同方式分为2组：（1）经直肠标本取出（双吻合器法）组29例：经肛门直肠取出根治标本，再以直线切割关闭器切断并关闭远端直肠，采用传统双吻合器法吻合；（2）经直肠标本取出（单吻合器法）组11例：经肛门直肠取出根治标本，直肠残端以倒刺线全层荷包缝合关闭，行单吻合器直肠结肠端端吻合。两组均行预防性末端回肠造口术。分析比较两组术中（手术时间、出血量）、术后指标（肛门排气时间、住院时间、术后进食流质时间），并观察治疗期两组相关并发症。采用电话随访或调查的形式，对末端造口回纳术后1年以上患者采用Wexner失禁评分评估术后肛门括约肌功能。 结果两组年龄、性别、BMI指数、肿瘤浸润深度、手术时间、术中出血量、肛门排气时间、进食流质时间、住院时间、并发症均无明显差异（P>0.05）；根据WIS评分，随访时间超过1年的26例患者中，20例（76.9%）患者术后肛门功能良好（WIS评分≤10分），无严重肛门失禁患者。 结论经肛门直肠标本取出式3D腹腔镜低位直肠前切除术中，采用单吻合器或双吻合器处理方式的临床效果无明显差异。

The clinical effects of trans-rectal extraction of specimen with double stapling anastomosis and trans-rectal extraction of specimen with single stapling anastomosis of 3D laparoscopic low anterior resection on rectal cancer

ObjectiveTo assess the clinical outcomes of trans-rectal extraction of specimen with double stapling anastomosis and trans-rectal extraction of specimen with single stapling anastomosis of 3D laparoscopic low anterior resection on rectal cancer. MethodsWe retrospectively analyzed the clinical and pathological features of 40 patients undergoing 3D laparoscopic anus-preserving operation for rectal cancer during January 2016 to March 2018 at Shanghai East Hospital. All patients were divided into two groups according to different anastomosis methods. (1) Twenty-nine cases were undergone trans-rectal extraction of specimen with double stapling anastomosis. Briefly, the specimen of rectum was moved out through the anus. Then an Endo linear cutting stapler was used to close the rectum. The anastomosis was accomplished with double-stapling technique. (2) Eleven cases were undergone trans-rectal extraction of specimen with single stapling anastomosis. After the specimen of rectum was moved out through the anus, the rectum was closed by purse-string suture with V-Loc stitches rather than the Endo linear cutting stapler. Then, the anastomosis was completed by a circular stapler in an end to end way. The operation time, blood loss, postoperative hospitalization days, exsufflation time, complications rates were compared between two groups. Wexner incontinence scoring criteria was used to assess the function of anal sphincter after the operation. ResultsThere was no significant difference between two groups in age, gender, BMI index, Tumor infiltration depth, operation time, blood loss, anal exhaust time, length of hospital stay, postoperative eating liquid time (P>0.05). According to WIS criteria, there were 76.9% patients whose anal sphincter function was good (WIS ≤10), and there was no patient with serious anal incontinence. ConclusionsIn 3D laparoscopic low anterior resection of rectal cancer, either trans-rectal extraction of specimen with double stapling anastomosis or trans-rectal extraction of specimen with single stapling anastomosis should be considered in an individualized way.