摘要
目的探讨完全机器人消化道重建联合改良右髂区辅助Trocar孔取出标本直肠癌根治术的临床疗效。方法采用回顾性描述性研究方法。收集2019年6月至2022年1月重庆大学附属三峡医院收治的139例直肠癌患者的临床资料;男81例,女58例;年龄为(64±15)岁。患者均行完全机器人消化道重建联合改良右髂区辅助Trocar孔取出标本直肠癌根治术。观察指标:(1)手术及术后情况。(2)随访情况。正态分布的计量资料以■±s表示,计数资料以绝对数表示。结果(1)手术及术后情况。139例患者均顺利施行完全机器人消化道重建联合改良右髂区辅助Trocar孔取出标本直肠癌根治术,无中转开腹、非计划重返手术及死亡患者。手术切口长度为(4.5±1.1)cm,手术时间为(157±63)min,术中出血量为(65±22)mL,术后首次下床时间为(2.36±0.29)d,术后首次肛门排气时间为(2.27±1.13)d,术后首次进食流质饮食时间为(2.90±1.12)d。术后第1、2、4天疼痛评分分别为(2.34±1.07)分、(1.26±0.36)分、(0.10±0.06)分。总住院时间为(8.92±2.15)d。术后病理学检查结果显示:淋巴结清扫数目为(18.1±2.3)枚,术后肿瘤远端切缘距离为(2.6±0.5)cm,肿瘤近端切缘距离为(13.1±2.6)cm,术后所有标本直肠系膜完整,环周切缘阴性。139例患者中,术后发生切口脂肪液化、吻合口漏、吻合口出血、肠梗阻各1例,均经治疗后好转出院;无腹壁切口感染和出血、乳糜漏、腹腔感染等并发症。(2)随访情况。139例患者术后均随访1年,无切口慢性感染、切口疝、切口肿瘤种植、切口慢性疼痛、性功能障碍、排尿困难及大小便失禁。结论完全机器人消化道重建联合改良右髂区辅助Trocar孔取出标本直肠癌根治术安全、可行,具有临床应用价值。
Objective To investigate the clinical effects of totally robotic digestive tract reconstruction and modified right iliac auxiliary Trocar hole for specimen extraction in radical proctectomy.Methods The retrospective and descriptive study was conducted.The clinical data of 139 patients with rectal cancer who were admitted to the Chongqing University Three Gorges Hospital from June 2019 to January 2022 were collected.There were 81 males and 58 females,aged(64±15)years.All patients underwent radical proctectomy with totally robotic alimentary tract reconstruction and modified right iliac auxiliary Trocar hole for specimen extraction.Observation indicators:(1)surgical and postoperative situations;(2)follow-up.Measurement data with normal distribution were represented as Mean±SD,and count data were represented as absolute numbers.Results(1)Surgical and postoperative situations.All the 139 patients completed radical proctectomy with totally robotic alimentary tract reconstruction and modified right iliac auxiliary Trocar hole for specimen extraction successfully,without conversion to laparotomy,unplanned return to surgery or death.The length of surgical incision was(4.5±1.1)cm,operation time was(157±63)minutes,volume of intraoperative blood loss was(65±22)mL,time to postoperative first out-of-bed activities was(2.36±0.29)days,time to first flatus was(2.27±1.13)days,and time to first liquid diet was(2.90±1.12)days.The pain scores at postoperative day 1,2,4 were 2.34±1.07,1.26±0.36,0.10±0.06.The hospitalization time was(8.92±2.15)days.Results of postoperative pathological examination:the number of lymph nodes dissected was 18.1±2.3,the distal resection margin distance of tumor was(2.6±0.5)cm,and the proximal resection margin distance of tumor was(13.1±2.6)cm.The mesorectum of all specimens was intact,and the circumferential resection margin was negative.Of 139 patients,1 case of incision fat liquefaction,1 case of anastomotic leakage,1 case of anastomotic bleeding,1 case of intestinal obstruction after operation were discharged after treatment.There was no complication such as abdominal infection or hemorrhage,chylous leakage,abdominal infection.(2)Followup.All the 139 patients were followed up for 1 year after operation.No chronic infection of abdominal incision,incisional hernia,incisional tumor implantation,chronic incision pain,sexual dysfunction,dysuria or fecal incontinence were found during the 1-year follow-up.Conclusion Totally robotic alimentary tract reconstruction and modified right iliac auxiliary Trocar hole for specimen extraction is safe and feasible in radical proctectomy,which has clinical application value.
作者
付正伟
樊奇
徐晶晶
熊德海
Fu Zhengwei;Fan Qi;Xu Jingjing;Xiong Dehai(Department of Intestinal Surgery,Chongqing University Three Gorges Hospital,Chongqing 404100,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2023年第S01期58-63,共6页
Chinese Journal of Digestive Surgery
基金
重庆大学附属三峡医院博士科研启动项目(2020BSKYQDJJ01)
重庆市万州区胃肠疾病诊疗技术创新研究中心项目(WZSTC⁃2017001)
关键词
直肠肿瘤
达芬奇机器人
经自然腔道标本取出术
消化道重建
疗效
Rectal neoplasms
Da Vinci robot
Natural orifice specimen extraction
Digestive tract reconstruction
Efficacy
