中国实用外科杂志

中国实用外科杂志

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腹腔镜辅助经肛全直肠系膜切除50例围手术期并发症分析

张安凯，刘鼎盛，崔明明，丛进春，张    宏   

  1. 中国医科大学附属盛京医院结直肠肿瘤外科，辽宁沈阳 110004
  • 出版日期:2020-05-01 发布日期:2020-05-15

  • Online:2020-05-01 Published:2020-05-15

摘要： 目的    探讨腹腔镜辅助经肛全直肠系膜切除（taTME）治疗低位直肠癌的围手术期并发症发生机制及预防策略。方法    回顾性分析2016年9月至2019年8月中国医科大学附属盛京医院结直肠肿瘤外科行腹腔镜辅助taTME的50例低位直肠癌病人临床资料，总结分析围手术期并发症的发生情况。结果    49例顺利完成了手术，1例因术中合并严重的CO2栓塞而行心肺复苏抢救治疗，之后中转开放手术。手术时间259（169～435）min，术中出血量50（20～300）mL。42例（84.0%）行机械吻合，8例（16.0%）手工吻合。所有手术均采取了预防性回肠造口。19例发生围手术期并发症（其中3例存在2种并发症，1例存在3种并发症），并发症发生率为38.0%。术中并发症有尿道损伤 1 例（2.0%）、CO2栓塞1 例（2.0%）,直肠穿孔2例（4%），神经血管束出血4例（8.0%），前列腺出血2例（4.0%）。术后并发症有吻合口漏 9 例（18.0%，其中A级漏2例，B级漏7例），炎性肠梗阻1例（2.0%），造口出口梗阻1例（2.0%），尿潴留2例（4.0%），肺部感染1例（2.0%），均经保守治疗后好转。 结论    腹腔镜辅助taTME因其特有的单孔操作特点及视角转变后的逆向游离路径，围手术期并发症较高，初期开展需要对其特有并发症及常见并发症有充分的认识和重视。

关键词: 直肠癌, 腹腔镜, 经肛全直肠系膜切除, 围手术期, 并发症

Abstract: Perioperative complications of laparoscope-assisted transanal total mesorectal excision：An analysis of 50 cases          ZHANG An-kai,LIU Ding-sheng,CUI Ming-ming,et al. Department of Colorectal Tumor Surgery, Shengjing Hospital, China Medical University, Shenyang 110004,China
Corresponding author: ZHANG Hong, E-mail： haojiubujian1203@sina.cn
Abstract    Objective    To investigate the mechanism and preventive strategies of perioperative complications in the laparoscope-assisted transanal total mesorectal excision（taTME）for low rectal cancer. Methods    The clinical data of 50 patients with low rectal cancer who underwent taTME in Department of Colorectal Tumor Surgery, Shengjing Hospital, China Medical University from September 2016 to August 2019 were analyzed retrospectively. The incidence of perioperative complications was analyzed. Results    Forty-nine cases completed the operation successfully. One case underwent cardiopulmonary resuscitation because of severe carbon dioxide embolism during operation, and then transferred to open operation. The median operation time was 259(169-435) min,and the median intraoperative blood loss was 50(20-300) mL. A total of 42 cases (84%) were anastomosed with instruments, and 8 cases (16%) were anastomosed by hand.All the patients underwent prophylactic ileostomy. Perioperative complications occurred in 19 cases (3 cases had 2 types of complications,1 case had 3 types of complications), the incidence of complications was 38.0%. Intraoperative complications included urethral injury in 1 case (2.0%), CO2 embolism in 1 case (2.0%), rectal perforation in 2 cases (4.0%), neurovascular bundle hemorrhage in 4 cases (8.0%), and prostatic hemorrhage in 2 cases (4.0%). Postoperative complications included anastomotic leakage in 9 cases (18.0%, grade A leakage in 2 cases, grade B leakage in 7 cases), inflammatory intestinal obstruction in 1 case(2.0%), stomatal outlet obstruction in 1 case (2.0%),urinary retention in 2 cases (4.0%), and pulmonary infection in 1 case. All the patients’ conditions had improved after conservative treatment. Conclusion    Laparoscope-assisted taTME has a high incidence of perioperative complications due to its characteristic single-hole operation and reverse dissociation path after visual angle change. It is necessary to fully understand and pay attention to its unique complications and common complications in the initial stage.

Key words: rectal cancer, laparoscope, transanal total mesorectal excision, perioperative period, complication