针孔式肛门括约肌间切除术及延迟结肠肛门吻合术用于低位直肠癌的短期结局分析
Short-term outcomes of the "minimal skin incision and no stoma" procedure in needlescopic intersphincteric resection and delayed coloanal anastomosis for low rectal cancer
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影响因子:2.9
分区:医学3区 / 胃肠肝病学3区 外科3区
发表日期:2024 Aug 16
作者:
T Mukai, S Matsui, T Sakurai, T Yamaguchi, T Akiyoshi, Y Fukunaga
DOI:
10.1007/s10151-024-02979-3
摘要
针孔手术采用直径为3毫米的细长套管，属于微创手术方法。我们在针孔手术中采用Turnbull-Cutait牵引术和延迟结肠肛门吻合术，旨在避免在低位直肠癌肛门括约肌间切除术中进行造口。在本研究中，我们评估了此“微创切口，无造口”手术的避免造口率和技术安全性。该单中心回顾性研究由日本癌症研究所医院进行，属于三级转诊中心。统计时间为2017年1月至2020年12月，共有11例患者接受针孔括约肌间切除伴造口（NSI组），另有19例患者接受针孔括约肌间切除伴延迟结肠肛门吻合（NSD组）。比较两组患者的背景资料、手术时间（239分钟对220分钟，p=0.68）、预计出血量（45克对25克，p=0.29）、R0切除率（均为100%，p=1.00）以及术后住院天数（16天对17天，p=0.42）。NSD组的避免造口率为94.4%。术后12个月的LARS（大肠功能障碍评分）和Wexner（大便控便评分）评分差异无统计学意义。结论显示，针孔肛门括约肌间切除和延迟结肠肛门吻合可在选择的患者中安全实施，具有较高的避免造口率及良好的短期结局。
Abstract
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.