[1]刘洪昌,王晓松,高林丰,等.达芬奇机器人直肠癌经括约肌间切除术超低位吻合相关并发症分析[J].第三军医大学学报,2019,41(18):1796-1801.
 LIU Hongchang,WANG Xiaosong,GAO Linfeng,et al.Complications associated with ultra-low anastomosis after robotic intersphincteric resection for low rectal cancer[J].J Third Mil Med Univ,2019,41(18):1796-1801.
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达芬奇机器人直肠癌经括约肌间切除术超低位吻合相关并发症分析(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第18期
页码:
1796-1801
栏目:
临床医学
出版日期:
2019-09-30

文章信息/Info

Title:
Complications associated with ultra-low anastomosis after robotic intersphincteric resection for low rectal cancer
作者:
刘洪昌王晓松高林丰张超罗华星余佩武唐波
陆军军医大学(第三军医大学)附属第一医院普通外科
Author(s):
LIU Hongchang WANG Xiaosong GAO Linfeng ZHANG Chao LUO Huaxing YU Peiwu TANG Bo

Department of General Surgery, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China

关键词:
超低位直肠癌并发症经括约肌间切除术机器人手术
Keywords:
ultra-low rectal cancer complications intersphincteric resection robotic surgery
分类号:
R615;R619;R735.37
文献标志码:
A
摘要:

目的分析直肠癌患者采用达芬奇机器人经括约肌间切除术超低位吻合相关并发症情况,总结其临床特征,为其防治提供依据。方法回顾性分析2015年1月至2019年3月本院收治的43例达芬奇机器人低位直肠癌经括约肌间切除术患者的临床资料。采用门诊和电话方式进行随访。观察常见并发症,包括:①肛门狭窄,②炎性外痔,③不全肠梗阻,④直肠阴道瘘,⑤吻合口漏,⑥新发直肠脱垂。其他指标包括术中失血量、手术时间、排便时间、恢复正常饮食时间、术后住院时间、术后病理、淋巴结数目、远切缘。结果患者均行达芬奇机器人直肠癌经括约肌间切除术及预防性末端回肠造瘘。其中19例(44.2%)患者术后出现肛门狭窄,以膜性狭窄为主,经定期扩肛后缓解。14例(32.6%)患者术后出现炎性外痔,中位缓解时间为术后33 (16~64) d。10例(23.3%)患者术后出现回肠造瘘口近端不全性肠梗阻,其中1例(2.3%)因保守治疗无效提前还瘘(术后35 d),其余保守治疗恢复后择期还瘘。2例(4.7%)患者术后出现吻合口漏。1例(2.3%)患者术后出现直肠阴道瘘。无新发直肠脱垂。单因素Logistic回归分析显示:男性是肛门狭窄的独立危险因素(P=0.002),炎性外痔的发生与手术时间有关(P=0.005)。结论达芬奇机器人直肠癌经括约肌间切除术超低位吻合相关并发症以肛门狭窄、炎性外痔和不全肠梗阻多见,加强早期预防、积极干预可取得较好的治疗效果。

Abstract:

ObjectiveTo investigate the complications associated with ultra-low anastomosis in robotic intersphincteric resection for rectal cancer and analyze their clinical characteristics for their prevention and treatment. MethodsWe retrospectively analyzed the clinical data of 43 patients undergoing robotic intersphincteric resection for low rectal cancer in our hospital between January, 2015 and March, 2019. The patients were followed up after the surgeries via outpatient visit and by telephone to assess the occurrence of anal stenosis, edematous hemorrhoids, partial intestinal obstruction, rectovaginal fistula, anastomotic leakage, and rectal mucosal prolapse. The surgical and perioperative data including intraoperative blood loss, operative time, defecation time, time to normal diet, postoperative hospital stay, postoperative pathology, the number of lymph nodes involved, and distal resection margin were also analyzed for the patients. ResultsAll the patients underwent robotic intersphincteric resection and prophylactic ileostomy. Postoperative anal stenosis (mainly membranous stenosis) was found in 19 patients (44.2%) after the surgery, and was relieved by regular anal expansion. Postoperative edematous hemorrhoids were found in 14 patients (32.6%) and remitted at a median of 33 d (range 16-64 d) after the operation. Among the 10 patients with partial intestinal obstruction, 1 patient underwent closure of ileostomy 35 d after operation, which was before the scheduled time; and in the remaining patients, ileostomy was closed by elective surgery after conservative treatment. Two patients experienced anastomotic leakage and 1 patient had rectovaginal fistula after the surgery (delayed fistula). No rectal prolapse occurred in these patients. Univariate logistic regression analysis showed that the male gender was an independent risk factor for anal stenosis (P=0.002), and the incidence of edematous hemorrhoids was correlated with the operation time (P=0.005). ConclusionAnal stenosis, edematous hemorrhoids, and partial intestinal obstruction are the most common complications associated with ultra-low anastomosis after robotic intersphincteric resection surgery for rectal cancer, and early preventive measures and active interventions can achieve favorable outcomes. 

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更新日期/Last Update: 2019-09-21