常文举, 任黎, 何国栋, 刘天宇, 吉美玲, 监谧, 陈伊教, 吕敏之, 韦烨, 许剑民. 用于机器人中低位直肠癌术后预防吻合口漏的一项新技术研究[J]. 中国肿瘤临床, 2021, 48(3): 132-139. DOI: 10.3969/j.issn.1000-8179.2021.03.607
引用本文: 常文举, 任黎, 何国栋, 刘天宇, 吉美玲, 监谧, 陈伊教, 吕敏之, 韦烨, 许剑民. 用于机器人中低位直肠癌术后预防吻合口漏的一项新技术研究[J]. 中国肿瘤临床, 2021, 48(3): 132-139. DOI: 10.3969/j.issn.1000-8179.2021.03.607
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Wenju Chang, Li Ren, Guodong He, Tianyu Liu, Meiling Ji, Mi Jian, Yijiao Chen, Minzhi Lv, Ye Wei, Jianmin Xu. An innovative technique to prevent low rectal anastomotic leakage in robotic rectal surgery[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2021, 48(3): 132-139. DOI: 10.3969/j.issn.1000-8179.2021.03.607
Citation: Wenju Chang, Li Ren, Guodong He, Tianyu Liu, Meiling Ji, Mi Jian, Yijiao Chen, Minzhi Lv, Ye Wei, Jianmin Xu. An innovative technique to prevent low rectal anastomotic leakage in robotic rectal surgery[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2021, 48(3): 132-139. DOI: 10.3969/j.issn.1000-8179.2021.03.607
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用于机器人中低位直肠癌术后预防吻合口漏的一项新技术研究

An innovative technique to prevent low rectal anastomotic leakage in robotic rectal surgery

    摘要
  • 摘要:
      目的  吻合口漏(anastomotic leakage，AL)是低位直肠癌保肛术后的严重并发症，亟需确切有效的预防措施。本研究旨在评估机器人低位直肠癌前切除术(low anterior resection，LAR)联合创新技术预防AL的临床价值。
      方法  选取2012年5月至2017年5月，于复旦大学附属中山医院接受机器人LAR治疗的601例患者，其中191例患者为对照组(non-PST组)，410例患者为治疗组(PST组)。分析比较两组AL发生率、围手术期结局和长期生存率；多因素回归分析机器人LAR术后AL的高危因素。
      结果  依据ISREC分级，601例患者的总体AL发生率为6.8%，其中B级为5.7%，C级为1.1%。其中PST组的总体AL发生率(5.1%)明显低于non-PST组(10.5%，P=0.015)；PST组的C级AL也明显改善(0.2% vs. 3.2%，P=0.005)。此外，PST组的手术并发症率(17.3% vs.20.9%，P=0.286)和再手术率(2.7% vs. 6.3%，P=0.038)较non-PST组均显著降低。长期结局分析提示两组的局部复发率和长期生存率无显著差异。多因素回归分析提示non-PST技术、术中出血量≥100 mL、吻合口距离肛缘＜5 cm以及远端切缘距离肿瘤＜2 cm分别是机器人LAR术后AL发生的高危因素。
      结论  机器人LAR联合PST技术是一种有效预防AL的方法，在临床实践中可避免常规实施保护性造口术。

     

    Abstract:
      Objective  To assess the role of an innovative technique in preventing anastomotic leakage (AL) in rectal cancer patients undergoing robotic low anterior resection (LAR).
      Methods  From May 2012 to May 2017, we included 601 patients who underwent robotic LAR: 410 patients underwent the innovative technique (PST group) and 191 patients were control subjects (non-PST group). We analyzed and compared the AL rate and short-term and long-term outcomes between the groups.
      Results  Using the ISREC grading system, the overall rate of AL was 6.8% (5.7% for Grade B and 1.1% for Grade C). The PST group had a lower incidence of overall AL (5.1% vs. 10.5%, P=0.015) and Grade C AL (0.2% vs. 3.2%, P=0.005) and lower rates of reoperation (2.7% vs. 6.3%, P=0.038) than the non-PST group; furthermore, both groups had similar surgical complication rates (17.3% vs. 20.9%, P=0.286). Short-term recovery and longterm oncological outcomes did not significantly differ between the two groups. Using multivariate Logistic regression models, the risk factors of AL in robotic LAR were the non-PST technique, an estimated blood loss ≥100 mL, anastomosis from anal verge < 5 cm, and a distal resection margin from tumors < 2 cm.
      Conclusions  The innovative PST technique may be an effective method in preventing the occurrence of AL in robotic LAR.

     

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