摘要
背景超低位直肠癌是指肿瘤下缘距离齿状线<5 cm的直肠癌,多由遗传、饮食、大肠慢性炎症等诸多因素所致.手术是治疗直肠癌的主要方法,虽可有效控制病情恶化,切除病变组织,但术后易出现吻合口瘘等并发症发生,不利于预后,甚至威胁患者生命健康,而老年患者术后吻合口瘘的防治更是临床的重点及难点.目的评估经骶前间隙双套管持续负压冲洗法在60岁以上老年腹腔镜超低位直肠癌根治保肛术后吻合口瘘中的应用效果.方法选择2018-11/2020-10就诊于本院的118例老年腹腔镜超低位直肠癌根治保肛术后吻合口瘘患者,根据入院顺序进行编号,采用电脑随机数字表法分为两组,对照组(59例)实施单腔引流管法,试验组(59例)接受经骶前间隙双套管持续负压冲洗法.对比两组疗效、各项指征恢复时间、术后功能、炎症因子.结果试验组治疗总有效率(98.31%)比对照组(84.75%)高,拔管时间、体温恢复正常时间、愈合时间、下腹部胀痛消失时间及住院时间均比对照组短(P<0.05);试验组治疗2 wk后视觉模拟评估量表评分比对照组低,肉芽生长等级及EORTC生命质量测定量表评分比对照组高(P<0.05);试验组治疗2 wk后白细胞计数、血沉、C反应蛋白、降钙素原水平比对照组低,血管内皮生长因子水平比对照组高(P<0.05).结论经骶前间隙双套管持续负压冲洗法治疗老年腹腔镜超低位直肠癌根治保肛术后吻合口瘘的效果显著,可快速缓解临床症状,促进新鲜肉芽生长,抑制炎症因子释放,改善生活质量.
BACKGROUND Ultra-low rectal cancer refers to rectal cancer where the lower edge of the tumor is less than 5 cm from the dentate line.It is mostly caused by genetics,diet,chronic inflammation of the large intestine,and many other factors.Surgery is the main method of treatment for rectal cancer.Although surgery can effectively control the deterioration of the disease and remove the diseased tissue,postoperative complications such as anastomotic leakage often occur,which is not conducive to the prognosis and even threatens the life and health of patients.The prevention and treatment of anastomotic leakage in elderly patients after surgery are a clinical focus and difficulty.AIM To evaluate the effect of continuous negative pressure irrigation with double cannula through the anterior sacral space in the treatment of anastomotic fistula after anus-preserving laparoscopic radical resection for ultra-low rectal cancer in elderly patients(over 60 years old).METHODS One hundred and eighteen elderly patients with anas-tomotic fistula after laparoscopic radical resection for ultra-low rectal cancer from November 2018 to October 2020 were selected and classified into either a control group or an experimental group according to the order of admission.The control group(59 cases)underwent single-chamber drainageed,and the experimental group(59 cases)received continuous negative pressure irrigation with double cannula through the presacral space.The efficacy,time to recovery of various indications,postoperative function,and inflammatory factors were compared between the two groups.RESULTS The total effective rate in the experimental group(98.31%)was significantly higher than that of the control group(84.75%),and the time to extubation,time to recovery of normal body temperature,healing time,time to disappearance of lower abdominal pain,and hospital stay were significantly shorter than those of the control group(P<0.05).The visual analogue assessment scale score of the experimental group was significantly lower than that of the control group after 2 wk of treatment,and the granulation growth grade and EORTC quality of life measurement scale score were significantly higher than those of the control group(P<0.05).After 2 wk of treatment,white blood cell count,erythrocyte sedimentation rate,C-reactive protein,and procalcitonin were significantly lower,and vascular endothelial growth factor level was significantly higher in the experimental group than in the control group(P<0.05).CONCLUSION Double cannula continuous negative pressure flushing through the presacral space is effective in the treatment of anastomotic fistula after anus-preserving laparoscopic radical resection for ultra-low rectal cancer in elderly patients,and it can quickly relieve clinical symptoms,promote the growth of fresh granulation,inhibit the release of inflammatory factors,and improve life quality.
作者
任慧
顾立强
陈晶晶
Hui Ren;Li-Qiang Gu;Jing-Jing Chen(Department of Surgery,Ninghe District Hospital,Tianjin 300000,China;Anorectal Treatment Center,Tianjin People’s Hospital,Tianjin 300121,China)
出处
《世界华人消化杂志》
CAS
2021年第13期741-746,共6页
World Chinese Journal of Digestology
关键词
老年
腹腔镜超低位直肠癌根治保肛术
吻合口瘘
骶前间隙
双套管持续负压冲洗法
Elderly
Laparoscopic radical resection of rectal cancer
Anastomotic leakage
Presacral space
Double cannula continuous negative pressure irrigation
