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目的探讨腹腔镜直肠癌经腹会阴联合切除术盆底腹膜重建的必要性、安全性及临床意义。方法回顾性分析我院2013年7月至2016年1月期间收治入院的37例低位直肠癌患者的临床资料,根据盆底腹膜是否重建分为盆底腹膜重建组(n=15)和盆底腹膜未重建组(n=22),比较未行盆底腹膜重建和行盆底腹膜重建两种治疗策略在术后相关并发症方面的差异。结果所有患者均顺利完成腹腔镜手术,无中转开腹者。手术时间(以超声刀切开乙状结肠和直肠系膜中线侧黄白交界处的右侧腹膜为开始,至完整切除直肠癌标本结束)为(173.6±18.3)min,盆底腹膜缝合关闭时间为(28.6±7.5)min。术后随访3~24个月,盆底腹膜未重建组共发生5例(22.7%)并发症,其中出现粘连性肠梗阻2例,盆腔积液并感染1例,会阴部切口疝1例,术后放疗引起放射性肠炎1例;盆底腹膜重建组仅发生1例(6.7%)粘连性肠梗阻并发症。2组术后总并发症发生率比较,差异无统计学意义(χ~2=2.367,P=0.096 1)。结论腹腔镜直肠癌经腹会阴联合切除手术中行盆底腹膜重建非必须,但对于术后需再次手术者可明显降低再次手术难度,尤其术后需放疗的患者,可预防放射性小肠炎的发生,因其更加符合开腹手术的原则仍有必要,用Hem-o-lok夹或3-0 Angiotech Quilltm倒刺缝线关闭盆底腹膜,技术上安全、可行。
Objective To investigate the necessity, safety and clinical significance of pelvic peritoneal reconstruction with laparoscopic transabdominal perineal resection. Methods The clinical data of 37 patients with low rectal cancer admitted to our hospital from July 2013 to January 2016 were retrospectively analyzed. According to whether pelvic peritoneum was reconstructed into pelvic peritoneal reconstruction group (n = 15) and pelvic floor Peritoneal un-reconstructed group (n = 22). The differences in postoperative complications between the two methods of pelvic peritoneal reconstruction and pelvic peritoneal reconstruction were compared. Results All patients were successfully completed laparoscopic surgery, no transit laparotomy. The operative time (starting from the right peritoneum at the yellow-white junction of the sigmoid colon and rectum mesorectum to the end of complete resection of the rectal cancer specimen) was (173.6 ± 18.3) min and the closing time of the pelvic peritoneal suture was (28.6 ± 7.5) min. Postoperative follow-up of 3 to 24 months, 5 cases (22.7%) of complications occurred in pelvic peritoneum non-reconstruction group, including 2 cases of adhesive intestinal obstruction, 1 case of pelvic fluid and infection, 1 case of perineal incisional hernia, Postoperative radiotherapy caused 1 case of radiation enteritis; pelvic peritoneal reconstruction group, only 1 case (6.7%) of adhesive intestinal obstruction complications. There was no significant difference in the incidence of postoperative complications between the two groups (χ ~ 2 = 2.367, P = 0.096 1). Conclusions Laparoscopic peritoneal resection of pelvic peritoneum with peritoneal resection of laparoscopic rectal cancer is not necessary, but for those patients who need surgery again, the difficulty of reoperation can be significantly reduced. In particular, radiotherapy for postoperative patients can prevent the occurrence of radiation enteritis, Because it is more in line with the principle of laparotomy is still necessary, with the Hem-o-lok clip or 3-0 Angiotech Quilltm barbed off the pelvic peritoneum, technically safe and feasible.