目的 探讨直肠癌前切除术吻合口漏的原因及对策。方法 对符合行直肠前切除术的73例直肠癌患者行全直肠系膜切除术,用双吻合器技术（double-stapling technique,DST）吻合结直肠。2004年1月以后收治的病例特别注意了会阴助推、 远侧直肠密闭试验、吻合器穿刺头穿刺点的选择、吻合口漏气试验和经肛门至结肠及经腹壁至吻合口旁放置引流管的技术细节。结果 全组2例(2.74%)发生吻合口漏，均为2004年1月以前的病例，1例经横结肠造瘘治愈，另1例经引流管冲洗治疗治愈； 2004年1月以后的65例无吻合口漏发生。结论 注意直肠癌前切除术中的一些技术细节， 可在一定程度上降低全直肠系膜切除条件下DST吻合的吻合口漏发生率。
Objective To assess the effectiveness of large-calibre (7.5#) transanal tube drainage and decompression on prevention from anastomotic leakage following anterior resection for rectal cancer. Methods Clinical data of 346 consecutive patients (M/F=1.39, age range 32-84 years, median age 58.5 years) undergone anterior resection for rectal cancer in this institute from January 2006 to December 2008 were analyzed retrospectively. Results The anastomotic leakage rate was 0 (0/185) and 5.59%(9/161) in patients with or without receiving large-calibre transanal tube drainage respectively. The anastomotic leakage rate was significantly decreased by large-calibre transanal tube drainage after anterior resection for rectal cancer (χ2=8.526, P=0.004). Eight cases of anastomotic leakage were treated conservatively and the other one required further surgical interventions. No perioperative death occurred in this series. Conclusion In this study, the large-calibre transanal tube drainage and decompression is effective in protecting rectal anastomosis and decreasing the rate of anastomotic leakage.
ObjectiveTo investigate the association between the preoperative nutritional risk and anastomotic leakage following anterior resection for the rectal cancer. MethodsA total of 321 patients with rectal cancer underwent anterior resection in our hospital between January 2008 and December 2013 were retrospectively analyzed. Preoperative nutritional status was evaluated using NRS 2002. Correlation of clinicopathologic characteristics with postoperative anastomotic leakage was evaluated using single factor analysis and Logistic regression model. ResultsAmong the 321 patients, the incidence of postoperative anastomotic leakage was 5.6% (18/321). Single factor analysis showed that the NRS2002 score≥3, clinicalpathologic stage (Ⅲ-Ⅳstage) and distance of tumor from the anal verge were the risk factors of anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Logistic regression analysis revealed that the NRS2002 score (OR=4.125, 95% CI=2.062-7.004), clinicalpathologic stage (OR=3.334, 95% CI=2.062-7.004) and the distance of tumor from the anal verge (OR=2.341, 95% CI=2.559-15.838) were the independent risk factors for anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Conciusions Preoperative NRS2002 score is helpful to predict the risk of anastomotic leakage after anterior resection of rectal cancer. Nutrition education should be strengthened to decrease the morbidity of the anastomotic leakage following anterior resection for the patients who's NRS2002 score≥3.
Objective To summary the early experience of Dixon procedures with Da Vinci robotics surgical system for rectal cancer. Methods Eleven patients with rectal cancer underwent the combination of laparoscope and Da Vinci robotics surgical system with 4 trocars in our hospital from May. 2011 to Jan. 2012. Laparoscopy was firstly used to identify the possibility of the surgical procedure， then placed the 4 trocars， and maked sure the suspension of the sigmoid colon and the uterus. Transections of rectum were performed by a conventional laparoscopic method， and endoscopic separations were performed by Da Vinci robotics surgical system. The clinical data were retrospectively analyzed and the experience was summarized. Results The Da Vinci robotics-assisted Dixon procedures were successfully performed in 11 patients and no one turned to laparotomy. The operating time was 210-330min （mean 288.6min）；the blood loss was 20-100ml （mean 40ml）； The number of lymph nodes dissected was 12-21 per case （mean 13.9 per case）；the duration of bowel movement and hospital stay were 18-26h （mean 22h） and 7-16d （mean 11.5d）， respectively. There were no intraoperative or postoperative complications related to the use of robotics， and no residual cancer cells at resection margin. Conclusions Da Vinci robotics-assisted Dixion procedure with 4 trocars and suspension of sigmoid colon are safe and feasible， and it is beneficial to the recovery of patients
ObjectiveThe low anterior resection syndrome (LARS) score is a simple and visual instrument assessing sphincter preserving surgery for low rectal cancer. The purpose of this study is to analyze the feasibility of using LARS score to assess the function after intersphincteric resection for low rectal cancer. MethodsBetween March 2013 and June 2015, 76 patients underwent sphincter preserving surgery for low rectal cancer, 23 cases underwent intersphincteric resection set as ISR group, the other 53 cases received low anterior resection set as LAR group. LARS score, Saito function questionnaire, Wexner score, and European organization for research and treatment of cancer (EORTC) quality of life questionnaire core 30 (QLQ-C30), questionnaire module for colorectal cancer (QLQ-CR29) were compared for the two groups. ResultsThere were 63.2 percent patients (48/76) appeared major LARS, 27.6 percent (21/76) minor LARS and 9.2 percent (7/76) no LARS, there were no statistically difference between the ISR and LAR groups (P=0.727), but the item of incontinence due to liquid stools appeared more obvious in ISR group (P=0.009). The items of faecel incontinence and sore skin for EORTC QLQ-CR29 were serious in ISR group (P < 0.05), the other item of EORTC QLQ-CR29 and EORTC QLQ-C30, Saito function questionnaire, Wexner score were similar between the two groups (all P > 0.05). ConclusionThe anal function after intersphincteric resection is non-inferior to the low anterior resection for low rectal cancer, but both can appear serious low anterior resection syndrome.
目的 探讨盲肠管道式造口持续减压方法防治直肠癌低位前切除术后吻合口漏的临床价值。方法 选择120例拟行直肠癌低位前切除手术患者，按机械抽样法随机分成2组，60例为盲肠管道式造口减压组（盲肠减压组），另外60例行常规手术作为对照。分析2组患者术后吻合口漏、消化道反应、呼吸系统感染及腹腔感染发生的差异及出现吻合口漏后的住院时间、开始进食时间和住院总费用。结果 盲肠减压组与常规手术组相比，发生吻合口漏〔(5.0%（3例）比13.3%（8例）〕、消化道反应〔15.0%（9例）比48.3%（29例）〕、呼吸系统感染〔11.7%（7例）比26.7%（16例）〕及腹腔感染〔11.7%（7例）比21.7%（13例）〕者均明显减少(Plt;0.05)。盲肠减压组中发生吻合口漏的患者与常规手术组中发生吻合口漏的患者相比，漏后住院时间〔（39±3） d比（53±4） d〕更短，进食〔（14±2） d比（25±3） d〕更早，住院总费用〔（39 620±2 033）元比（46 750±2 131）元〕降低，差异均有统计学意义(Plt;0.05)。结论 盲肠管道式造口持续减压能有效降低直肠癌低位前切除术后吻合口漏的发生率。
ObjectiveTo study the risk factors affecting anterior resection syndrome of rectal cancer. MethodsSixty-seven patients with low rectal cancer who performed anus preserving operation in Second Artillery General Hospital from August 2013 to October 2014 were screened out based on inclusion and exclusion criteria. Forty-two cases received low anterior resection (LAR), 25 cases received intersphincter resection (ISR). Patients were followed-up for 1 year. The severity of anterior resection syndrome was evaluated by using score system for anterior resection syndrome. The patients' age, gender, body mass index (BMI), TNM stage, surgical mode, surgical approach, anastomotic height, prophylactic colostomy, adjuvant chemotherapy, and radiotherapy were used as research indicators, and to evaluate the impact to anterior resection syndrome. ResultsThe single factor analysis showed that the surgical mode, preventive stoma, radiotherapy, anastomotic height, and age were related to the severity of anterior resection syndrome (P < 0.05). Logistic regression showed that the surgical mode (OR=4.506, 95% CI: 1.220, 16.640, P=0.024) and radiotherapy (OR=14. 688, 95% CI: 3.200, 67.429, P=0.001) were related to the severity of anterior resection syndrome. ConclusionSurgical mode and radiotherapy are the independent risk factors of anterior resection syndrome.