摘要
目的总结分析腹腔镜辅助经肛全直肠系膜切除术(taTME)治疗新辅助治疗后的直肠癌患者近期并发症发生情况及其临床处理对策。方法检索2016年6月至2018年8月期间,北京大学肿瘤医院前瞻性taTME数据库中,经病理明确诊断且术前行新辅助放化疗的直肠癌患者共29例,男25例,女4例,中位年龄60(30~72)岁。体质指数中位数为25.8(19.8~36.4)kg/m2,肿瘤下缘距肛门距离中位数为4(2~8)cm。taTME手术分为经腹组和经肛组同时进行操作。分析本组患者围手术期并发症(术后3个月内发生)发生情况,尤其吻合口相关并发症的发生及其临床处理对策。手术相关并发症按照Clavien-Dingo(CD)分级标准记录。吻合口漏和吻合口狭窄严重程度按照国际直肠癌研究组制订的标准进行评价。结果全组29例患者均顺利完成腹腔镜辅助taTME手术,无中转开腹,无术中严重并发症及死亡病例;中位手术时间300(198~405)min,中位手术出血量100(50~200)ml,手术标本的TME质量按照Nagtegaal标准均为完整。所有患者均接受了预防性回肠造口。1例术中因近端肠管血运不佳无法行吻合改为Hartmann手术。全组手术肛门括约肌保留率96.6%(28/29)。全组患者术后排气时间中位数2(1~10)d,住院时间中位数为9(7~24)d。51.7%(15/29)的患者术后出现并发症,严重并发症(CD分级Ⅲb级及以上者)占6.9%(2/29),无围手术期死亡。17.2%(5/29)出现吻合口相关并发症,包括C级吻合口漏2例,均为吻合口断裂,于术后1个月行腹会阴联合切除;B级吻合口漏2例,经保守治疗后均好转;吻合口A级狭窄1例,术后1个月扩肛后好转。术后感染发生率为24.1%(7/29),其中盆腔感染6例,戳卡部位感染1例,均为CD分级Ⅱ级;发生小肠部位不全肠梗阻1例(CD分级Ⅱ级);胃瘫1例;腹壁戳孔疝1例。全组患者获随访,中位随访时间12.0(3.9~29.9)个月,共有7例尚未行回肠造口还纳,肛门括约肌保留率为75.9%(22/29)。结
Objective To summarize and analyze the postoperative short-term complications of laparoscope-assisted transanal total mesorectal excision (taTME) for rectal cancer patients after neoadjuvant therapy. Methods A prospectively established database on taTME patients at Peking University Cancer Hospital was screened with the following conditions: data retrieval from June 2016 to August 2018, pathologically confirmed adenocarcinoma, receiving preoperative neoadjuvant chemoradiotherapy or chemotherapy. The transabdominal procedure and the transanal procedure were performed simultaneously in the taTME operation. Occurrence of complications during perioperative period (within postoperative 3 months) in these patients, especially anastomosis-related complications and their management were analyzed. The relevant complications were recorded according to the Clavien-Dindo (CD) grading criteria. The severity of anastomotic leakage and anastomotic stenosis was evaluated according to criteria developed by the International Rectal Cancer Research Group. Results A total of 29 patients were enrolled in this study. In the 29 patients, 25 (86.2%) were male and 4 (13.8%) were female, the median age was 60 (range, 30 to 72) years, the median body mass index was 25.8 (range, 19.8 to 36.4) kg/m2, the median distance from the tumor to anal verge was 4 (range, 2 to 8) cm. All the patients completed laparoscope-assisted taTME operations successfully without conversion to laparotomy, intra-operative severe complication or death. The median operation time was 300 (range, 198 to 405) minutes, and the median intra-operative blood loss was 100 (range, 50 to 200) ml. All the TME specimens were complete according to the Nagtegaal standard. All the patients underwent prophylactic ileostomy. Hartmann procedure was performed in one case due to poor blood supply in the proximal bowel without the possibility of anastomosis. Anal sphincter preservation rate was 96.6%(28/29). The median postoperative exhaust time was 2 (range, 1 to 10) days, and the medi
作者
刘新志
何国礼
李英杰
董秋石
张晓
孙婷婷
王林
姚云峰
武爱文
Liu Xinzhi;He Guoli;Li Yingjie;Dong Qiushi;Zhang Xiao;Sun Tingting;Wang Lin;Yao Yunfeng;Wu Aiwen(Department 3 of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China;Department of general surgery, Nanxishan Hospital, Guangxi ZhuangAutonomous Region, Guangxi Guilin 541000, China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2019年第3期255-261,共7页
Chinese Journal of Gastrointestinal Surgery
基金
国家自然科学基金(81773214).
关键词
直肠肿瘤
经肛全直肠系膜切除术
新辅助治疗
术后并发症
Rectal neoplasms
Transanal total mesorectal excision
Neoadjuvant therapy
Postoperative complications
