作者：蔡灿锋1，李锦宏1，辛海洋1，陈国星1，陈翔1，汪荣1，唐超明1，曾军1，曾兵2

单位：1.广州医科大学附属第六医院 普通外科，广东 清远 511518；2.中山大学附属第六医院 胃肠、疝和腹壁外科，广东 广州 510655

Authors: Cai Canfeng1, Li Jinhong1, Xin Haiyang1, Chen Guoxing1, Chen Xiang1, Wang Rong1, Tang Chaoming1 ,

Zeng Jun1, Zeng Bing2

Unit: 1.Department of General Surgery, the Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan 511518, Guangdong, China； 2.Department of Gastroenterology, Hernia and Abdominal Wall Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong, China

摘要：

目的 探讨改良悬吊法(截石位2点和10点)在腹腔镜中低位直肠癌手术直肠前间隙分离中的应用价值。方法 回顾性分析2017年10月至2019年12月在广州医科大学附属第六医院接受腹腔镜中低位直肠癌手术,并且收集直肠前间隙分离时采用腹膜反折悬吊法患者的手术录像等临床资料。观察改良悬吊法和传统悬吊法(截石位12点)完成时间、直肠前间隙分离完成时间、直肠前间隙分离过程中出血量、神经血管束(neurovascular bundle, NVB)损伤情况及悬吊并发症发生情况。结果 改良悬吊组32例,传统悬吊组39例,改良悬吊组较传统悬吊组完成时间长[(261.88±42.61) s比(155.64±31.52) s, P<0.001]。改良悬吊组直肠前间隙分离完成时间较传统悬吊组短[(19.03±3.29) min比(24.95±4.24) min, P<0.001]。改良悬吊组直肠前间隙分离过程中,10例有出血,出血量(2.40±1.17) ml; 传统悬吊组直肠前间隙分离过程中,12例有出血,出血量(9.33±3.42) ml; 两组出血例数比较差异无统计学意义(P=0.965),改良悬吊组较传统悬吊组出血量少,差异具有统计学意义(P<0.001)。传统悬吊组NVB损伤5例,改良悬吊组无NVB损伤,差异具有统计学意义(P=0.036)。改良悬吊组穿刺点出血3例,传统悬吊组穿刺点出血5例,差异无统计学意义(P=0.65)。结论 在腹腔镜中低位直肠癌手术中,采用腹膜反折切开线改良悬吊法有利于直肠前间隙的分离。

关键词：  腹腔镜; 直肠癌; 腹膜反折; 改良悬吊法

Abstract：

Objective To explore the application value of the modified suspension method (2 and 10 points in lithotomy position) in the separation of anterior rectal space in laparoscopic middle and low rectal cancer surgery. Methods Retrospective analysis of clinical data of patients undergoing laparoscopic middle and low rectal cancer surgery in the Sixth Affiliated Hospital of Guangzhou Medical University from October 2017 to December 2019, and using the retroperitoneal suspension method in the separation of anterior rectal space. Complete time of modified suspension method and traditional suspension method (12 points of lithotomy position), complete time of anterior rectal space separation, amount of bleeding during anterior rectal space separation, injury of neurovascular bundle (neurovascular bundle, NVB) and occurrence of suspension complications were observed. Results There were 32 cases in the modified suspension group and 39 cases in the traditional suspension group. The modified suspension group took longer to complete than the traditional suspension group [(261.88 ±42.61)s vs (155.64 ±31.52)s, P<0.001]. The separation time of the anterior rectal space separation in the modified suspension group was shorter than that in the traditional suspension group [(19.03 ±3.29)min vs (24.95 ±4.24)min, P<0.001]. During the separation of the anterior rectal space in the modified suspension group, 10 patients had bleeding, with an average bleeding volume (2.40 ±1.17) ml. During the separation of the anterior rectal space in the traditional suspension group, 12 patients had bleeding with an average bleeding volume (9.33 ±3.42) ml. There was no statistically significant difference in the number of bleeding cases between the two groups (P=0.965). The modified suspension group had less bleeding than the traditional suspension group, and the difference was statistically significant (P<0.001). During the separation of anterior rectal space, there were 10 cases of bleeding in the modified suspension group, average bleeding volume (2.40±1.17) ml, and 12 cases of bleeding in the traditional suspension group, average bleeding volume (9.33±3.42) ml. There was no statistically significant difference in the number of bleeding cases between the two groups (P=0.965). But the amount of bleeding in modified suspension group was less than that in traditional suspension group, and the difference was statistically significant (P<0.001). There were 5 cases of NVB injury in the traditional suspension group and no NVB injury in the modified suspension group. The difference was statistically significant (P=0.036). There were 3 cases of bleeding at the puncture point in the modified suspension group and 5 cases of bleeding at the puncture point in the traditional suspension group (P=0.65). Conclusion In laparoscopic surgery for low rectal cancer, the modified suspension method of peritoneal reflex incision is beneficial to the separation of the anterior rectal space.

Key Words: Laparoscope; Rectal cancer; Peritoneal reflex; Modified suspension method