中国实用外科杂志

中国实用外科杂志

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关闭盆底腹膜联合骶前冲洗负压引流用于机器人直肠癌腹会阴联合切除术疗效分析

曹传林，刘东宁，唐    城，江群广，端木尽忠，李太原   

  1. 南昌大学第一附属医院普外科，江西南昌 330006
  • 出版日期:2016-11-01 发布日期:2016-10-27

  • Online:2016-11-01 Published:2016-10-27

摘要：

目的    探讨关闭盆底腹膜联合骶前冲洗负压引流用于机器人直肠癌腹会阴联合切除术（APR）的可行性和有效性。方法    回顾性分析2014年12月至2016年4月南昌大学第一附属医院行机器人APR的59例低位直肠癌病人的临床资料，其中术中关闭盆底腹膜并行骶前冲洗负压引流31例（关闭组），未关闭盆底腹膜且采用常规重力引流28例（未关闭组）。比较两组病人术中及术后情况。结果    两组均无中转开放手术病例，关闭组病人均成功关闭盆底腹膜。关闭组和未关闭组手术时间分别为（186.6±23.0）min 和（176.9±19.4）min，差异无统计学意义（P=0.088）。在并发症方面，关闭组会阴部切口感染发生率低于未关闭组（6.5% vs. 32.1%，P=0.011），二者肠梗阻发生率（3.2% vs. 10.7%，P=0.337）和会阴疝发生率（0 vs. 7.1%，P=0.221）差异无统计学意义。两组术中出血量、淋巴结清扫数、环周切缘阳性率及引流管放置时间差异均无统计学意义（P>0.05）。未关闭组出现1例肿瘤复发。结论    机器人直肠癌APR术中关闭盆底腹膜并联合骶前冲洗负压引流可明显降低会阴切口感染发生率。

关键词: 机器人手术系统, 直肠肿瘤, 盆底腹膜, 负压引流, 腹会阴联合切除术

Abstract:

Application of pelvic peritoneum reconstuction accompanied with irrigation and negative pressure drainage in robotic abdominoperineal resection for rectal cancer        CAO Chuan-lin，LIU Dong-ning，TANG Cheng，et al. Department of General Surgery，the First Affiliated Hospital of Nanchang University，Nanchang 330006，China
Corresponding author：LI Tai-yuan，E-mail：jylitaiyuan@sina.com
Abstract    Objective    To explore feasibility and efficacy of pelvic peritoneum reconstuction (PPR) accompanied with irrigation and negative pressure drainage after robotic abdominoperineal resection (APR) for rectal cancer. Methods    The clinical data of 59 cases of low-rectal cancer patients treated from December 2014 to April 2016 in the First Affiliated Hospital of Nanchang University were analyzed retrospectively. Among all the cases, 31 cases received PPR accompanied with irrigation and negative pressure drainage in robotic APR (closed group) and 28 cases received gravity drainage without PPR (unclosed group). Operative and postoperative details were compared between two groups. Results No conversion occurred in the two groups. The pelvic peritoneum was closed successfully in closed group. There was no significant difference between the two groups in terms of operation time ［(186.6±23.0) min vs. (176.9±19.4)min，P=0.088］，incidence of perineal hernia ［0(0/31) vs. 7.1%(2/28)，P=0.221］ and incidence of intestinal obstruction ［3.2%(1/31) vs. 10.7%(3/28)，P=0.337］. Compared with unclosed group，closed group displayed lower incision infection rate ［6.5%(2/31) vs. 32.1%(9/28)，P=0.011］. The intra-oprerative blood loss，the number of retrieved lymph node，positive circumferential resection margin and time to remove the drainage tube were similar between two groups. One case of tumor recurrence occurred in unclosed group. Conclusion    PPR is necessary after robotic APR for rectal cancer，which accompanied with irrigation and negative pressure drainage might significantly reduce incidence of complications.

Key words: robotic surgical system, rectal neoplasms, pelvic peritoneum, negative pressure drainage, abdominoperineal resection