切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 14 -19. doi: 10.3877/cma.j.issn.1674-3946.2021.01.004

所属专题: 述评/论坛 总编推荐 文献

专家论坛

中国腹腔镜直肠癌手术30年术后主要并发症防治策略
王贵英1,(), 胡旭华2, 张宁2, 李保坤2, 张建锋2, 周超熙2, 王光林2, 王飞飞2   
  1. 1. 050011 河北医科大学第四医院外二科;河北医科大学第三医院外科
    2. 050011 河北医科大学第四医院外二科
  • 收稿日期:2020-01-23 出版日期:2021-02-10
  • 通信作者: 王贵英

Prevention and therapeutic strategies of major complications after laparoscopic rectal cancer surgery, Chinese experience in the past 30 years

Guiying Wang1,(), Xuhua Hu2, Ning Zhang2, Baokun Li2, Jianfeng Zhang2, Chaoxi Zhou2, Guanglin Wang2, Feifei Wang2   

  1. 1. The Second Department of Surgery, the Fourth Hospital of Hebei Medical University; Department of Surgery, the Third Hospital of Hebei Medical University
    2. The Second Department of Surgery, the Fourth Hospital of Hebei Medical University
  • Received:2020-01-23 Published:2021-02-10
  • Corresponding author: Guiying Wang
  • Supported by:
    Key Project of Hebei Precision Medicine Joint Foundation(206Z7705G); Cancer Research Program of National Cancer Center(NCC2017A23); Key project of medical science research program of Hebei Province(20160194)
引用本文:

王贵英, 胡旭华, 张宁, 李保坤, 张建锋, 周超熙, 王光林, 王飞飞. 中国腹腔镜直肠癌手术30年术后主要并发症防治策略[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(01): 14-19.

Guiying Wang, Xuhua Hu, Ning Zhang, Baokun Li, Jianfeng Zhang, Chaoxi Zhou, Guanglin Wang, Feifei Wang. Prevention and therapeutic strategies of major complications after laparoscopic rectal cancer surgery, Chinese experience in the past 30 years[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(01): 14-19.

随着腹腔镜器械的进步及手术技术的发展,腹腔镜直肠癌根治手术已经成为目前的主流术式。腹腔镜直肠癌手术能够提供更好的手术视野、更精细化的解剖认知、更小创伤的微创治疗理念,在国内外均获得了较好的临床疗效。此外随着大样本前瞻性随机对照试验(RCT)研究数据的发表,让我们也消除了腹腔镜直肠癌手术对于肿瘤学不良结局的顾虑。但是,腹腔镜直肠癌手术后的相关并发症仍临床治疗的难点和重点,也令外科医师们存在一定的敬畏。本文通过对近几年国内外文献的复习并结合我中心的治疗经验,以阐明腹腔镜直肠癌术后常见并发症类型、病因以及防治策略,为降低腹腔镜直肠癌术后并发症发生率提供更多的经验。

With the advancement of laparoscopic instruments and the development of surgical techniques, laparoscopic rectal cancer surgery has become the current mainstream operation. Laparoscopic rectal cancer surgery could provide better surgical vision, more refined anatomy, with less injury, and could achieve better clinical outcome both in China and abroad. Accumulated data from large-sample prospective randomized controlled trials (RCT) research eliminated the concept that laparoscopic rectal cancer surgery might result in a poor oncology outcome. However, complications related to laparoscopic rectal cancer surgery are still the challenge in clinical application for some surgeons. Based on domestic and foreign literatures in recent years and combined with the treatment experience of our center, this article clarifies the types of common complications, causes and prevention strategies after laparoscopic rectal cancer surgery, in order to provide reference to reduce the incidence of complications after laparoscopic rectal cancer surgery.

图1 吻合口漏典型病例(照片由河北医科大学第四医院外二科提供)。[男,63岁,腹腔镜下直肠癌根治术后6个月拟行回肠造口还纳入院,下消化道造影提示吻合口漏(A, B),电子结肠镜示吻合口狭窄,伴窦道形成(C)。]
表1 国际直肠癌研究组的吻合口漏分级[9]
图2 直肠癌术后吻合口狭窄球囊扩张后造影结果(照片由河北医科大学第四医院外二科提供)
图3 直肠癌术后吻合出血合并吻合口漏内镜下OTSC应用病例(照片由河北医科大学第四医院外二科提供)。[男,66岁,腹腔镜下直肠癌术后3 h,肛门便血200 ml,急诊内镜检查可见吻合口渗血(A),同时合并吻合口右后壁约1 cm漏口(B),行OTSC夹闭漏口及渗血肠壁(C)疗效确切,术后6月复查,可见吻合口愈合良好(D),伴部分金属夹残留。]
[1]
Jacobs M, Verdeja JC, Goldstein HS.Minimally invasive colon resection (laparoscopic colectomy) [J]. Surg Laparosc Endosc,1991, 1(3): 144-150.
[2]
Green BL, Mashall HC, Collinson F,et al.Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopic ally assisted resection in colorectal cancer [J]. Br J Surg, 2013, 100(1): 75-82.
[3]
Bonjer HJ, Deijen CL, Abis GA,et al.A randomized trial of laparoscopic versus open surgery for rectal cancer [J]. N Engl J Med, 2015, 372(14): 1324-1332.
[4]
Jeong S-Y, Park JW, Nam BH,et al.Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiother apy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial [J]. Lancet Oncol, 2014, 15(7): 767-774.
[5]
Bakker IS, Snijders HS, Wouters MW,et al.High complication rate after low anterior resection for mid and high rectal cancer; results of a popu lation-based study [J]. Eur J Surg Oncol, 2014, 40(6): 692-698.
[6]
Yang C-S, Choi G-S, Park JS,et al.Rectal tube drainage reduces major anastomotic leakage after minimally invasive rectal cancer surgery [J].Colorectal Dis,2016,18(12): O445-O452.
[7]
戴志慧,杜金林,王建平,等.保护性横结肠襻式造口对腹腔镜直肠癌前切除术后吻合口漏及狭窄的影响[J].中华消化外科杂志,2014, 13(7): 535-538.
[8]
Tong DKH, Fan JKM, Law WL.Outcome of laparoscopic colorectal resection [J]. Surgeon, 2008, 6(6): 357-360.
[9]
Rahbari NN, Weitz J, Hohenberger W, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer[J]. Surgery, 2010, 147(3): 339-351.
[10]
中华医学会外科学分会结直肠外科学组.中国直肠癌手术吻合口漏诊断、预防及处理专家共识(2019版) [J].中华胃肠外科杂志,2019, 22(3): 201-206.
[11]
Parthasarathy M, Greensmith M, Bowers D,et al.Risk factors for anastomotic leakage after colorectal resection: a retrospective analysis of 17518 patients[J]. Colorectal Dis, 2017, 19(3): 288-298.
[12]
Sparreboom CL, van Groningen JT, Lingsma HF, et al. Different Risk Factors for Early and Late Colorectal Anastomotic Leakage in a Nationwide Audit[J]. Dis Colon Rectum, 2018, 61(11): 1258-1266.
[13]
Tanaka K, Okuda J, Yamamoto S, et al. Risk factors for anastomotic leakage after laparoscopic surgery with the double stapling technique fo r stage 0/I rectal carcinoma: a subgroup analysis of a multicenter, single-arm phase II trial[J]. Surg Today, 2017, 47(10): 1215-1222.
[14]
Detry RJ, Kartheuser A, Delriviere L,et al.Use of the circular stapler in 1000 consecutive colorectal anastomoses: experience of one surgical team[J].Surgery, 1995, 117(2): 140-145.
[15]
Fang Y-C, Ning F-L, Zhang C-D,et al.Preservation versus non-preservation of left colic artery in sigmoid and rectal cancer surgery: A met a-analysis[J]. Int J Surg, 2018, 52: 269-277.
[16]
黄俊,周家铭,万英杰,等.肠系膜下动脉血管分型及Riolan动脉弓缺如对腹腔镜直肠癌根治术后吻合口瘘发生率的影响[J].中华胃肠外科杂志,2016,19(10): 1113-1118.
[17]
刘友强,胡旭华,韩佳旭,等.淋巴结清扫对不同临床病理分期直肠癌根治术患者恢复及生存预后的影响[J].中华老年医学杂志,2020, 39(6): 676-679.
[18]
吴作友,黄平,陈启,等. 结肠系膜作屏障在腹腔镜下游离结肠脾曲中的应用 [J].中国微创外科杂志,2018,18(8): 724-727.
[19]
Kawada K, Sakai Y.Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopi c low anterior resection with double stapling technique anastomosis [J]. World J Gastroenterol, 2016, 22(25): 5718-5727.
[20]
Kawada K, Hasegawa S, Hida K, et al. Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis[J].Surg Endosc,2014, 28(10): 2988-2995.
[21]
池畔,王枭杰,林惠铭,等.肠镜下被膜自膨式金属支架置入治疗结直肠癌术后吻合口瘘的疗效及并发症分析[J].中华胃肠外科杂志,2015,18(7): 661-666.
[22]
Zhou J-L,Shen BEndoscopic needle knife therapy for anastomotic leakage following anterior resection for rectal cancer[J].Colorectal Dis,2012,14(6): e365-e366.
[23]
Rondelli F, Reboldi P, Rulli A, et al. Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis[J].Int J Colorectal Dis, 2009, 24(5): 479-488.
[24]
黄海涛,王振军.直肠癌全直肠系膜切除术术后吻合口狭窄的病因分析及外科诊治[J].临床外科杂志,2020, 28(5): 441-443.
[25]
Bannura GC, Cumsille MA, Barrera AE, et al. Predictive factors of stenosis after stapled colorectal anastomosis: prospective analysis of 179 cons ecutive patients[J]. World J Surg, 2004, 28(9): 921-925.
[26]
贾文焯,孙建华,吴国举,等.直肠癌Dixon术后吻合口良性狭窄的外科诊治[J]. 中国全科医学,2016, 19(3): 268-271.
[27]
傅传刚,郝立强.低位直肠癌保肛术后吻合口漏与狭窄原因及治疗[J].中国实用外科杂志,2014, 34(9): 851-854.
[28]
Kim MJ, Shin R, Oh HK, et al. The impact of heavy smoking on anastomotic leakage and stricture after low anterior resection in rect al cancer patients [J]. World J Surg, 2011, 35(12): 2806-2810.
[29]
Kozol RA, Hyman N, Strong S,et al.minimizing risk in colon and rectal surgery[J]. Am J Surg, 2007, 194(5): 576-587.
[30]
Neutzling CB, Lustosa SA, Proenca IM,et al.Stapled versus handsewn methods for colorectal anastomosis surgery[J].Cochrane Database Syst Rev,2012,2: CD003144.
[31]
姚嘉,周卫平.双吻合器技术在中低位直肠癌保肛术中的应用54例分析[J/CD]. 中华普外科手术学杂志(电子版), 2012, 6(1): 36-41.
[32]
Guyton KL, Hyman NH, Alverdy JC.Prevention of Perioperative Anastomotic Healing Complications: Anastomotic Stricture and Anastomotic Leak[J].Adv Surg, 2016, 50(1): 129-141.
[33]
Hayden DM, Pinzon MCM, Francescatti AB,et al.Patient factors may predict anastomotic complications after rectal cancer surgery: Anastomotic compli cations in rectal cancer[J].Ann Med Surg (Lond), 2014, 4(1): 11-16.
[34]
中国医师协会外科医师分会结直肠外科医师委员会,中国医师协会结直肠肿瘤专业委员会器官功能保护专业委员会,中国医师协会肛肠医师分会,等.直肠癌骶前复发诊疗专家共识[J].中华胃肠外科杂志,2020, 23(5): 438-444.
[35]
Bravi I, Ravide D, Fiori G,et al.Endoscopic electrocautery dilation of benign anastomotic colonic strictures: a single-center experience[J].Surg Endosc, 2016, 30(1): 229-232.
[36]
詹磊磊,刘宇虎,陈桂权.经内镜放射状切开术在治疗结直肠吻合口良性狭窄中的临床应用[J].中国内镜杂志,2019, 25(7): 82-85.
[37]
Jex RK, van Heerden JA, Wolff BG,et al. Gastrointestinal anastomoses. Factors affecting early complications[J]. Ann Surg, 1987, 206(2): 138-141.
[38]
Kayano H, Nomura E, Ueda Y,et al.Short-term outcomes of OTSC for anastomotic leakage after laparoscopic colorectal surgery[J].Minim Invasive Ther Allied Technol, 2020, 1-8.
[39]
Kim S-H, Park I-J, Joh Y-G,et al.Laparoscopic resection for rectal cancer: a prospective analysis of thirty-month follow-up outcomes i n 312 patients[J].Surg Endosc,2006, 20(8): 1197-1202.
[40]
Guillou PJ, Quirke P, Thorpe H, et al.Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial[J].Lancet,2005, 365(9472): 1718-1726.
[1] 燕速, 霍博文. 腹腔镜食管胃结合部腺癌根治性切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 13-13.
[2] 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14.
[3] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[4] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[5] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[6] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[7] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[8] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[9] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[10] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[11] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[12] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[13] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[14] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[15] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?