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首页> 外文期刊>Surgical endoscopy >Predicting the level of difficulty of the double-stapling technique in laparoscopic total mesorectal excision
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Predicting the level of difficulty of the double-stapling technique in laparoscopic total mesorectal excision

机译：预测腹腔镜全直肠系膜切除术双吻合技术的难度

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Background The transection of rectum and fashioning of anastomosis is a crucial step in laparoscopic total mesorectal excision (TME) and the double-stapling technique (DST) is often employed. This study aimed to evaluate the factors that were associated with difficult DST. Method Cases of laparoscopic TME were retrospectively reviewed. The clinico-anatomical parameters were retrieved from a prospectively maintained database. In addition, pelvic dimensions were taken by reviewing the magnetic resonance imaging scan. The number of stapler cartridges used for intracorporeal transection of rectum was used as a surrogate for the level of difficulty of DST and its relationship with various parameters were evaluated. Results There were a total of 121 consecutive cases analyzed. The mean number of stapler cartridges used was 2.1 +/- 0.7. Pelvic inlet (p = 0.002) and tumor height (p = 0.015) were predictors of the number of cartridges used,R-2 = 0.366. A model was developed to predict the likelihood of transecting the rectum with two or less stapler cartridges, which included the following parameters: gender, pelvic inlet, interspinous distance, intertuberous distance, and tumor height. The predicted probability also correlated with overall operation time (p = 0.009) and anastomotic leakage (p = 0.023). Conclusion The difficulty of DST was associated with patient's clinico-anatomical factors. Surgeons can consider other feasible alternatives, like transanal anastomosis, when a technically challenging DST is anticipated.
机译：背景 直肠的横断和吻合口的形成是腹腔镜全直肠系膜切除术 （TME） 的关键步骤，通常采用双吻合技术 （DST）。本研究旨在评估与困难 DST 相关的因素。方法 回顾性分析腹腔镜TME病例。临床解剖参数是从前瞻性维护的数据库中检索的。此外，通过查看磁共振成像扫描来测量骨盆尺寸。用于直肠体内横断的吻合器盒的数量被用作DST难度水平的替代物，并评估其与各种参数的关系。结果 共分析了121例连续病例。平均使用的订书机墨盒数量为 2.1 +/- 0.7。盆腔入口 （p = 0.002） 和肿瘤高度 （p = 0.015） 是所用药盒数量的预测因子，R-2 = 0.366。开发了一个模型来预测使用两个或更少的吻合器盒横切直肠的可能性，其中包括以下参数：性别、盆腔入口、棘突间距离、结节间距离和肿瘤高度。预测概率还与总手术时间（p = 0.009）和吻合口瘘（p = 0.023）相关。结论 DST的难易程度与患者的临床解剖学因素有关。外科医生可以考虑其他可行的替代方案，例如经肛门吻合术，当预计 DST 在技术上具有挑战性时。

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