摘要
目的:探讨腹腔镜下直肠癌前切除术治疗低位直肠癌对手术指标的影响及并发直肠阴道瘘(RVF)相关因素。方法:回顾性分析2010年1月至2020年10月于我院接受腹腔镜直肠癌前切除术的137例及接受开腹直肠癌前切除术的132例女性低位直肠癌患者的临床资料,分别设为腹腔镜组与开腹组。开腹组行常规开腹直肠癌前切除术,腹腔镜组在腹腔镜辅助下行直肠癌前切除术。对比两组围术期相关临床指标(手术时间、术中出血量、肠管近端切除长度、肠管远端切除长度、术后首次排气时间、术后首次下床时间、住院时间)差异;再统计腹腔镜组住院期间RVF发生情况,依据患者是否发生分为RVF组与非RVF组,对比RVF组与非RVF组基础资料信息差异,并将有差异信息纳入Logistic模型,行量化赋值,以是否发生RVF作为因变量(Y,是=1),以是否绝经、肿瘤距肛缘距离、Duke's分期、吻合方式、是否预防性末端回肠造口为自变量,明确低位直肠癌患者腹腔镜直肠癌前切除术治疗后发生RVF的危险因素。结果:两组手术时间、肠管近端切除长度、肠管远端切除长度对比差异无统计学意义(P>0.05);腹腔镜组术中出血量、术后首次排气时间、术后首次下床时间、住院时间均少于开腹组,差异有统计学意义(P<0.05)。经统计腹腔镜组患者住院期间13例发生RVF,发生率为9.49%,将发生RVF的患者设为RVF组(n=13),未发生RVF者设为非RVF组(n=124)。两组BMI、居住地区、病理类型、是否吸烟、是否饮酒对比差异无统计学意义(P>0.05);RVF组≥60岁、绝经、肿瘤距肛缘距离≤6cm、Duke's分期C期、双吻合、无预防性末端回肠造口患者占比显著多于非RVF组,差异有统计学意义(P<0.05)。多因素Logistic回归分析证实,≥60岁、绝经、肿瘤距肛缘距离≤6cm、Duke's分期C期、双吻合、无预防性末端回肠造口为低位直肠癌患者腹腔镜直肠癌前切除术治疗后发生RVF的危险因素,均有P<0.05。结论:相对于开腹治疗,腹腔镜下直肠癌前切除术治疗低位直肠癌能够减少术中出血,且患者术后恢复快,经多因素Logistic回归分析证实腹腔镜直肠癌前切除术治疗后发生RVF受到较多因素的影响,临床医师应当予以密切关注。
Objective:To investigate the influence of laparoscopic anterior resection for low rectal cancer on surgical parameters and related factors of rectovaginal fistula(RVF).Methods:Retrospective analysis was performed on the clinical data of 137 patients who received laparoscopic anterior resection for rectal cancer and 132 women who received open anterior resection for low rectal cancer in our hospital from January 2010 to October 2020,and they were divided into the laparoscopic group and the open group.The laparotomy group received conventional anterior resection for rectal cancer,while the laparoscopy group received laparoscopic assisted anterior resection for rectal cancer.The differences of perioperative clinical indicators(operative time,intraoperative blood loss,length of proximal bowel resection,length of distal bowel resection,postoperative first exhaust time,postoperative first out of bed time,and hospital stay length)were compared between the two groups.The occurrence of RVF was analyzed and the patients were accordingly divided into RVF group and non RVF group,whose basic information was compared and the difference was applied to the Logistic model and quantified with RVF as the dependent variable(Y=1),with menopause,tumor distance from anal edge,Duke's stage,consistent way,the terminal ileum preventive colostomy as independent variables.Risk factors of RVF were clarified.Results:There were no statistically significant differences between the two groups in operation time,length of proximal bowel resection and length of distal bowel resection(P>0.05).Intraoperative blood loss,postoperative exhaust time,postoperative out of bed time and hospital stay length in the laparoscopic group were all lower than those in the open group,and the differences were statistically significant(P<0.05).After statistical analysis,RVF occurred to 13 patients in the laparoscopic group during hospitalization,with an incidence of 9.49%.Patients with RVF were set as RVF group(n=13),and those without RVF were set as the non-RVF group(n=124).There was no significant difference in BMI,living area,pathological type,smoking and alcohol consumption between the two groups(P>0.05).The proportion of patients in RVF group≥60 years old,menopause,tumor distance from the anal edge≤6cm,Duke's stage C,double anastomosis and no preventive terminal ileostomy was significantly higher than that in the non-RVF group,and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis confirmed that≥60 years of age,menopause,tumor distance from the anal edge≤6cm,Duke's stage C,double anastomosis,and non-prophylactic terminal ileostomy were all risk factors for RVF after laparoscopic anterior rectal resection for patients with low rectal cancer(P<0.05).Conclusion:Compared with open treatment,laparoscopic anterior rectal resection for low rectal cancer can reduce intraoperative bleeding,and patients recover quickly after surgery.Multivariate Logistic regression analysis confirmed that RVF after laparoscopic anterior rectal cancer resection was affected by many factors,which should be paid close attention to by clinicians.
作者
贾凌威
王曼
陈礼升
JIA Lingwei;WANG Man;CHEN Lisheng(Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430000,China)
出处
《河北医学》
CAS
2021年第3期461-466,共6页
Hebei Medicine
基金
湖北省自然科学基金项目,(编号:2018CFB240)。
关键词
低位直肠癌
直肠癌前切除术
腹腔镜
直肠阴道瘘
Low rectal cancer
Anterior resection of rectal cancer
Laparoscope
Rectovaginal fistula
