CAJ | 학술논문

目的探讨分次游离闭合肿瘤远端肠管在腹腔镜直肠癌低位前切除术中的应用效果及可行性,提高中低位直肠癌保肛率,降低手术难度.方法回顾性分析72例中、低位直肠癌患者的临床资料,分别采取游离直肠右侧壁及右后侧壁闭合切断部分右侧肠管,完全游离直肠左侧壁及左后侧壁闭合切断部分左侧肠管(A组)和完全游离后闭合肿瘤下缘远端肠管(B组)的方法完成腹腔镜保肛手术.结果 A、B两组观察指标比较,A组患者的术中出血量、手术时间、中转开腹率均低于B组,差异有统计学意义(P＜0.05).两组肿瘤下缘距切缘距离、淋巴结检出数、首次排气时间、术后住院时间、术后吻合口狭窄及术后吻合口瘘发生率比较差异均未见统计学意义(P＞0.05).结论分次闭合远端肠管的方法可以有效地降低腹腔镜低位前切除术中的手术难度,减少出血量,缩短手术时间及降低中转开腹率.
목적 탐토분차유리폐합종류원단장관재복강경직장암저위전절제술중적응용효과급가행성,제고중저위직장암보항솔,강저수술난도.방법 회고성분석72례중、저위직장암환자적림상자료,분별채취유리직장우측벽급우후측벽폐합절단부분우측장관,완전유리직장좌측벽급좌후측벽폐합절단부분좌측장관(A조)화완전유리후폐합종류하연원단장관(B조)적방법완성복강경보항수술.결과 A、B량조관찰지표비교,A조환자적술중출혈량、수술시간、중전개복솔균저우B조,차이유통계학의의(P＜0.05).량조종류하연거절연거리、림파결검출수、수차배기시간、술후주원시간、술후문합구협착급술후문합구루발생솔비교차이균미견통계학의의(P＞0.05).결론 분차폐합원단장관적방법가이유효지강저복강경저위전절제술중적수술난도,감소출혈량,축단수술시간급강저중전개복솔.
Objective To study the effects and feasibility of twice closed the distal bowel of tumor on laparoscopic low anterior resection,and thus to improve the success rate of sphincter-preserving and reduce the operation difficulty.Methods The clinical data of 72 patients with mid-low rectal caner were retrospectively analyzed.Free right lateral wall and posterior wall of rectum were taken respectively closed to cut off the part of the right side of the bowel,completely free after rectum left side and left side closed to cut off the part on the left side of the bowel loops (group A),and completely free after closed lower edge of the distal bowel tumor (group B) method to complete laparoscopic anal surgery.Results The blood loss,operative time and open surgery rate of group A were less than that of group B (P ＜0.05).There were no significant differences in the distance from the dentate line to the edge of tumor,the number of lymph nodes,duration of first passing flatus,postoperative hospital stay and the incidence of complications (P ＞ 0.05).Conclusions Twice closed the distal bowel of tumor can effectively reduce the difficulty of laparoscopic low anterior resection in some cases,reducing blood loss,and shorten the operative time and reduce the rate of open surgery.