研究动态
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低位直肠癌针镜下括约肌间切除术和延迟结肠肛管吻合术中“最小皮肤切口和无造口”手术的短期结果。

Short-term outcomes of the "minimal skin incision and no stoma" procedure in needlescopic intersphincteric resection and delayed coloanal anastomosis for low rectal cancer.

发表日期:2024 Aug 16
作者: T Mukai, S Matsui, T Sakurai, T Yamaguchi, T Akiyoshi, Y Fukunaga
来源: PHARMACOLOGY & THERAPEUTICS

摘要:

针镜手术是一种微创手术,使用直径为 3 毫米的细套管针。我们在针镜手术中使用了Turnbull-Cutait 拉穿术和延迟结肠吻合术,以避免在低位直肠癌括约肌间切除术中改变回肠造口术。在本研究中,我们旨在评估这种“最小皮肤切口、无造口”手术的改道性回肠造口避免率和技术安全性。这项单中心回顾性研究是在日本三级转诊中心癌症研究所医院进行的。 2017年1月至2020年12月期间,11例患者接受了针镜下括约肌间切除加转道回肠造口术(NSI组),19例患者接受了针镜下括约肌间切除加延迟结肠吻合术(NSD组)治疗低位直肠癌。比较各组患者的背景和短期结局数据,包括改道性回肠造口避免率、病理结果和术后排便功能。NSI组和NSD组在患者背景、手术时间方面无统计学差异(239 分钟与 220 分钟,p = 0.68)、估计失血量(45 g 与 25 g,p = 0.29)、R0 切除率(100% 与 100%,p = 1.00)以及术后住院时间(16天与 17 天,p = 0.42)。 NSD 组的改道性回肠造口避免率为 94.4%。术后 12 个月的 LARS 和 Wexner 评分在两组之间没有显着差异。针镜下括约肌间切除术和延迟结肠肛管吻合术可以在选定的患者中安全地进行,具有较高的转道回肠造口避免率和可比的短期结果。© 2024。瑞士施普林格自然股份公司。
Needlescopic surgery is a minimally invasive procedure that uses thin trocars with 3-mm diameter. We used Turnbull-Cutait pull-through and delayed coloanal anastomosis in needlescopic surgery to avoid diverting ileostomy during intersphincteric resection for low rectal cancer. In this study, we aim to assess the diverting ileostomy avoidance rate and technical safety of this "minimal skin incision and no stoma" procedure.This single-center retrospective study was conducted at the Cancer Institute Hospital, a tertiary referral center in Japan. Between January 2017 and December 2020, 11 patients underwent needlescopic intersphincteric resection with diverting ileostomy (NSI group), and 19 patients underwent needlescopic intersphincteric resection with delayed coloanal anastomosis (NSD group) for low rectal cancer. Data regarding patient backgrounds and short-term outcomes, including diverting ileostomy avoidance rate, pathological results, and postoperative defecatory function, were compared between the groups.There were no statistically significant differences between the NSI and NSD groups with respect to patient background, operation time (239 min versus 220 min, p = 0.68), estimated blood loss (45 g versus 25 g, p = 0.29), R0 resection rate (100% versus 100%, p = 1.00), and length of postoperative hospital stay (16 days versus 17 days, p = 0.42). The diverting ileostomy avoidance rate was 94.4% in the NSD group. The LARS and Wexner scores 12 months after surgery were not significantly different between the two groups.Needlescopic intersphincteric resection and delayed coloanal anastomosis can be safely performed in selected patients with a high rate of diverting ileostomy avoidance and comparable short-term outcomes.© 2024. Springer Nature Switzerland AG.