限制性结肠脾曲游离技术在腹腔镜直肠癌低位前切除术中的临床应用

doi:10.3877/cma.j.issn.2095-3224.2020.01.010

中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (01) : 46 -50. doi: 10.3877/cma.j.issn.2095-3224.2020.01.010

所属专题：文献；

论著

限制性结肠脾曲游离技术在腹腔镜直肠癌低位前切除术中的临床应用

李赟¹, 刁德昌²^,^†(

), 李洪明², 卢新泉², 易小江², 万进², 邓晨辉²

^1. 330006　南昌大学第一附属医院胃肠外科
^2. 510120　广州中医药大学第二附属医院（广东省中医院）结直肠外科

收稿日期:2019-06-23 出版日期:2020-02-20
通信作者: 刁德昌
基金资助:
中国博士后科学基金面上项目(2018M633694)

Clinical application of limited-splenic flexure mobilization technique in laparoscopic low anterior resection for rectal cancer

Yun Li¹, Dechang Diao²^,^†(), Hongming Li², Xinquan Lu², Xiaojiang Yi², Jin Wan², Chenhui Deng²

^1. Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
^2. Department of Colorectal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China

Received:2019-06-23 Published:2020-02-20
Corresponding author: Dechang Diao

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目的

评价限制性脾曲游离（LSFM）技术在腹腔镜直肠癌低位前切除术中的应用效果和安全性。

方法

回顾性总结分析2018年6月至2019年3月间广东省中医院收治的75例直肠癌患者临床病理资料，按照脾曲游离方法分为LSFM组（35例）和完全性脾曲游离（CSFM）组（40例）。

结果

两组患者均能完成腹腔镜下的直肠-结肠的无张力吻合，未发生术中毗邻脏器的医源性损伤，手术标本质量分级（Nagtegaal分级）均为3级。两组患者的手术时间无显著性差异（176.8±55.7 vs 205.5±72.4 min，P>0.05），但LSFM组的脾曲游离时间明显短于CSFM组（4.5±3.1 vs 25.4±9.3 min，P<0.01）。术中出血量、预防性造口比例、淋巴结清扫数目、术后首次肛门排气时间、术后住院时间、盆腔引流管引流量、引流管留置时间和术后并发症发生率两组间差异均无统计学意义（P>0.05）。两组均无术后30 d内再住院、再手术和死亡病例。

结论

在腹腔镜直肠癌低位前切除术中行LSFM是安全可行的，与CSFM相比可以明显缩短手术时间，降低手术难度，并能取得同样满意的游离效果。

关键词: 脾曲, 解剖学, 结直肠, 手术学, 腹腔镜

Objective

To assess the effectiveness and safety of limited-splenic flexure mobilization (LSFM) technique in laparoscopic low anterior resection for rectal cancer.

Methods

The clinical pathological data of 75 patients with rectal carcinoma administered in Guangdong Province Hospital of Chinese Medicine from June 2018 to March 2019 were collected and analysed retrospectively. According to the methods of splenic flexure mobilization, these patients were devided into LSFM group (35 cases) and completed-splenic flexure mobilization (CSFM) group (40 cases).

Results

The tension-free anastomosis between rectum and colon could be achieved without any iatrogenic injury of adjacent organs among the two groups. The qualities of all the surgical specimens were assessed as 3 grade in line with Nagtegaal specimens quality grading system. There was no significant difference of operative time between the two groups (176.8±55.7 vs 205.5±72.4 min, P>0.05), but special time for splenic flexure mobilization in LSFM group were shorter significantly than those in CSFM group (4.5±3.1 vs 25.4±9.3 min, P<0.01). The differences of intraoperative blood loss, prevalence of preventive stoma, number of harvested lymphnodes, first time of postoperative flatus, length of postoperative hospital stays, drainage of pelvic drainage tube, indwelling time of drainage tube and incidence rate of postoperative complication were not of significance between the two groups (P>0.05). There was no rehospitalization, reoperation and death within 30 days postoperatively in the two groups.

Conclusions

LSFM method applied in laparoscopic low anterior resection for rectal cancer is safe and feasible. It the can achieve a satisfactory mobilization effect as CSFM technique, accompanied by much shorter operative time and lower difficulty.

Key words: Splenic flexure, Anatomy, Colorectum, Operative procedure, Laparoscope

图1 向上切开降结肠外侧腹膜后见膈结肠韧带阻挡在前方

图2 继续向上完全离断膈结肠韧带

图3 限制性结肠脾曲游离后即可充分显露脾脏，脾结肠韧带得以保留

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