结直肠外科专业化程度对腹腔镜低位直肠癌手术预防性造口的影响

目的:探讨结直肠外科专业化程度对腹腔镜低位直肠癌手术中行预防性造口的影响。方法:采用回顾性队列研究方法,收集2017年1月至2020年6月收治并经病理确诊的107例腹腔镜低位直肠癌手术患者的临床资料,分为专业组(n=57例)与非专业组(n=50例)。观察两组术中情况、术后吻合口漏及其他并发症发生情况。结果:两组术中出血量差异无统计学意义(P=0.69)。专业组手术时间(124.9±4.22)min vs.(150.1±4.81)min]、预防性造口率(29.8%vs.58.0%)小于非专业组,淋巴结清扫数量(12.21±0.26)枚vs.(10.90±0.31)枚]多于非专业组,差异有统计学意义(P<0.01)。术后21例(19.6%)患者发生吻合口漏,专业组与非专业组术后总体吻合口漏发生率(17.5%vs.22.0%,P=0.56)差异无统计学意义;但预防性造口患者中专业组吻合口漏发生率(47.1%vs.17.2%,P=0.001)高于非专业组;而在非预防性造口患者中专业组吻合口漏发生率(6.7%vs.28.6%,P=0.03)低于非专业组。两组术后尿潴留、切口感染、肺部感染、肠梗阻发生率差异均无统计学意义(P>0.05)。结论:腹腔镜低位直肠癌前切除术中专业化的外科治疗可更加合理地选择预防性造口,减少预防性造口的例数。

The effect of colorectal surgery specialization on preventive stoma during laparoscopic surgery for lower rectal cancer

Objective:To investigate the effect of colorectal surgery specialization on preventive stoma during laparoscopic surgery for lower rectal cancer.Methods:The retrospective cohort study was performed on the clinical data of 107 patients who were diagnosed with low rectal cancer by pathology and underwent laparoscopic operation from Jan.2017 to Jun.2020.According to the doctor's professional degree,patients were divided into professional group(n=57)and non-professional group(n=50).The intraoperative conditions,postoperative anastomotic leakage and other complications of the two groups were observed.Results:There was no significant difference in the intraoperative blood between the two groups(P=0.69).In professional group,the operation time(124.9±4.22)min vs.(150.1±4.81)min]and the rate of preventive stoma(29.8%vs.58.0%)were less than those in non-professional group,the number of lymph node dissected(12.21±0.26)vs.(10.90±0.31)]was more than that in non-professional group(P<0.01).The total incidence of anastomotic leakage was 19.6%(n=21),it was similar between professional group and non-professional group(17.5%vs.22.0%,P=0.56).While in preventive stoma patients,the incidence of anastomotic leakage of professional group was higher than that of non-professional group(47.1%vs.17.2%,P=0.001).And for patients without preventive stoma,the anastomotic leakage of professional group was lower than that of non-professional group(6.7%vs.28.6%,P=0.03).There was no significant difference in postoperative complications between the two groups(P>0.05),such as urinary retention,incision infection,pulmonary infection,intestinal obstruction.Conclusions:Colorectal surgery specialization can more reasonably choose preventive stoma and reduce its rates in laparoscopic anterior resection of low rectal cancer.