盆底腹膜重建在3D腹腔镜辅助直肠前切除术中的价值

doi:10.3877/cma.j.issn.1674-6899.2018.02.008

中华腔镜外科杂志(电子版) ›› 2018, Vol. 11 ›› Issue (02): 94 -97. doi: 10.3877/cma.j.issn.1674-6899.2018.02.008

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盆底腹膜重建在3D腹腔镜辅助直肠前切除术中的价值

付正伟 ¹, 王丽霞 ², 张振宇 ¹, 罗颀枫 ¹, 葛海燕 ¹ ^, ^†(

)

^1. 200120 上海，同济大学附属东方医院胃肠肛肠外科
^2. 445000 恩施，武汉大学恩施临床学院消毒供应中心

收稿日期:2018-01-26 出版日期:2018-04-30
通信作者: 葛海燕
基金资助:
上海市科学技术委员会面上项目(34119b0600; 16411970800)

The value of pelvic peritoneal reconstruction in 3D laparoscopic assisted anterior resection of rectum

Zhengwei Fu ¹, Lixia Wang ², Zhenyu Zhang ¹, Qifeng Luo ¹, Haiyan Ge ¹ ^, ^†( )

^1. Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
^2. Disinfection Supply Center, Enshi Clinical College, Wuhan University School of Medicine, Enshi 445000 , China

Received:2018-01-26 Published:2018-04-30
Corresponding author: Haiyan Ge
About author:
Corresponding author: Ge Haiyan, Email: gesurgery@163.com

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目的

探讨盆底腹膜重建在3D腹腔镜低位直肠癌Dixon术的手术方法、安全性及临床运用价值。

方法

回顾性分析同济大学附属东方医院胃肠肛肠外科2015年3月至2016年7月的178例低位直肠癌行3D腹腔镜Dixon术并术中行盆底腹膜重建的临床资料，总结其手术技巧、安全性及临床应用价值。

结果

178例患者在3D腹腔镜下顺利完成手术，无中转开腹，成功重建盆底腹膜。手术时间(150.78 ± 30.20)min，重建盆底腹膜时间(18.13 ± 6.71)min，术中出血量(61.00 ± 12.67)ml，术后住院时间(10.34 ± 2.65)d，术后下床时间(2.85 ± 1.14)d，回肠造口通气时间(2.96 ± 0.83)d，术后进食时间(3.45 ± 1.30)d，术后拔管时间(4.69 ± 1.71)d，术后远切缘(2.87 ± 0.70)cm，术后环周切缘均为阴性，术后出现吻合口瘘2例。术后随访1年，未发现粘连性肠梗阻、放射性肠炎及盆底腹膜裂口疝等并发症。

结论

3D腹腔镜低位直肠癌Dixon术并术中盆底腹膜重建在技术上安全可行，具有重要的运用价值，值得临床推广。

关键词: 直肠癌, 盆底腹膜重建, 3D腹腔镜, Dixon术

Objective

To investigate the surgical methods, safety and clinical value of pelvic peritoneal reconstruction in three- dimensional laparoscopic Dixon for low rectal cancer.

Methods

The clinical data of 178 cases of low rectal cancer which were made pelvic peritoneum reconstruction in 3D laparoscopic assisted Dixon from Mar. 2015 to Jul. 2016 were retrospectively analyzed. The surgical techniques, safety and clinical value were summarized.

Results

178 patients underwent 3D laparoscopic assisted Dixon without laparotomy and the pelvic peritoneum were reconstructed successfully. The mean operation time was (150.78 ± 30.20)min, the pelvic peritoneum reconstruction time was(18.13 ± 6.71)min, the intraoperative blood loss was(61.00 ± 12.67)ml, the postoperative hospitalization time was(10.34 ± 2.65)days, the bed ambulation time was(2.85 ± 1.14)days and the ileostomy ventilation time was(2.96 ± 0.83)days, the postoperative eating time was (3.45 ± 1.30)days, the time of drainage tube was(4.69 ± 1.71)days, the distal margin was (2.87 ± 0.70)cm, and the circumferential incised margins were all negative. 2 patients were occurred anastomotic leakage. The patients were followed up for one year, the adhesive intestinal obstruction, radiation enteritis, pelvic peritoneal cleft hernia and other complications were not found.

Conclusions

The pelvic peritoneal reconstruction in 3D laparoscopic assisted Dixon for low rectal cancer were safe and feasible and has important application value. The pelvic peritoneal reconstruction in 3D laparoscopic assisted Dixon were worthy of clinical promotion.

Key words: Rectal cancer, Pelvic peritoneal reconstruction, Three- dimensional laparoscopy, Dixon

图1 3D腹腔镜盆底腹膜重建的步骤及技术要领

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