经预定肠造口部位入路单孔腹腔镜治疗低位直肠癌的安全性与可行性分析

Safety and feasibility of single-port laparoscopic surgery via the predetermined enterostomy site for low rectal cancer

摘要:

背景与目的 单孔腹腔镜手术可进一步减少腹壁创伤并改善美容效果，但其在低位直肠癌中的应用仍存在技术挑战。对于需行肠造口的患者，经预定造口部位建立单孔操作通道可避免额外腹壁切口。本研究旨在评估经预定肠造口部位入路单孔腹腔镜治疗低位直肠癌的安全性、可行性及短期临床效果。方法 回顾性分析2020年9月—2023年9月川北医学院附属医院收治的184例低位直肠癌患者临床资料。根据手术方式分为单孔腹腔镜组（单孔组）与传统多孔腹腔镜组（多孔组），其中经回肠预防性造口入路患者116例（单孔组58例，多孔组58例），经乙状结肠永久性造口入路患者68例（单孔组34例，多孔组34例）。比较两组患者基线资料、术中指标及术后短期结局。结果 两组患者术前基线特征比较差异均无统计学意义（均P>0.05）。无论在回肠造口还是乙状结肠永久性造口患者中，单孔组手术时间均长于多孔组（均P<0.001），但术中出血量差异无统计学意义（均P>0.05）。两组在淋巴结清扫数目、肠功能恢复时间、平均住院时间、并发症发生率、术后出血、住院期间死亡及30 d内再住院率方面差异均无统计学意义（均P>0.05）。单孔组术后第1~3天视觉模拟评分低于多孔组，患者主观满意度更高（均P<0.05）。中位随访23个月，未观察到与术式相关的严重远期并发症。结论 经预定肠造口部位入路单孔腹腔镜治疗低位直肠癌安全可行，可在保证近期疗效的基础上减少腹壁创伤、减轻术后疼痛并提高患者满意度，具有良好的临床应用前景。

Abstract:

Background and Aims Single-port laparoscopic surgery may further reduce abdominal wall trauma and improve cosmetic outcomes; however, its application in low rectal cancer remains technically challenging. For patients requiring enterostomy, establishing a single-port access through the predetermined stoma site may avoid additional abdominal incisions. This study aimed to evaluate the safety, feasibility, and short-term outcomes of single-port laparoscopic surgery via the enterostomy site in patients with low rectal cancer.Methods A retrospective analysis was conducted on 184 patients with low rectal cancer treated at the Affiliated Hospital of North Sichuan Medical College between September 2020 and September 2023. According to the surgical approach, patients were divided into a single-port laparoscopy group (single-port group) and a conventional multi-port laparoscopy group (multi-port group). Among them, 116 patients underwent surgery via prophylactic ileostomy access (58 in each group), and 68 underwent surgery via permanent sigmoid colostomy access (34 in each group). Baseline characteristics, intraoperative outcomes, and short-term postoperative outcomes were compared between the groups.Results No significant differences were observed in baseline clinicopathologic characteristics between the two groups (all P>0.05). In both ileostomy and permanent sigmoid colostomy subgroups, operative time was significantly longer in the single-port group than in the multi-port group (all P<0.001), whereas intraoperative blood loss was comparable between the groups (all P>0.05). No significant differences were found in the number of harvested lymph nodes, time to bowel function recovery, postoperative hospital stay, postoperative complications, postoperative bleeding, in-hospital mortality, or 30 d readmission rates (all P>0.05). The single-port group demonstrated lower postoperative visual analogue scale pain scores on postoperative days 1-3 and higher patient satisfaction scores than the multi-port group (all P<0.05). The median follow-up duration was 23 months, and no severe procedure-related long-term complications were observed.Conclusion Single-port laparoscopic surgery via the predetermined enterostomy site for low rectal cancer is safe and feasible. This technique can reduce abdominal wall trauma, alleviate postoperative pain, and improve patient satisfaction while maintaining satisfactory short-term outcomes, showing promising clinical application potential.