| Objective: To investigate the clinical value of surgical area’s effusion bacterial culture in laparoscopic transanal total mesorectal excision(Lap-taTME)and laparoscopic total mesorectal excision(Lap-TME).Methods: From September 2017 to August 2019,the clinical data of106 patients who underwent rectal cancer radical resection successfully in gastrointestinal surgery department of the First Affiliated Hospital of Chongqing Medical University were retrospectively collected,there were56 patients in the Lap-taTME group(observation group)and 50 patients in the Lap-TME group(control group).There were no significant differences in sex,height,body mass index(BMI),preoperative carcinoembryonic antigen(CEA)between the two groups(P >0.05).The operation in the observation group was divided into transabdominal group and transanal group,aseptic cotton swabs dipped the initial effusion in the pelvic cavity before transabdominal operation were recorded as culture No.1,dipped therectal cavity effusion after purse-string suture during transanal operation were recorded as culture No.2 and dipped the pelvic cavity effusion through the abdominal wall after anastomosis were recorded as culture No.3.In the control group,aseptic cotton swabs dipped the initial effusion in the pelvic cavity before transabdominal operation were recorded as culture No.1 and dipped the pelvic cavity effusion after anastomosis were recorded as culture No.3.The intraoperative situation,postoperative pathology,culture results and postoperative complications were statistically analyzed and compared.Results: Both the observation group and the control group had no conversion to laparotomy or rectal perforation,there were no significant differences between the two groups in terms of intraoperative presacral bleeding,urethral injury and average bleeding(all P > 0.05).There was significant difference in the average operation time between the observation group and the control group.The postoperative pathological reports showed that the positive rate of distal margin,proximal margin and circumferential resection margin(CRM)in the both two groups were zero,and there were no significant differences between the two groups in vascular invasion,neurological invasion,total number of lymph nodes detected and pathological TNM stage(all P > 0.05).In the observation group and the control group,the positive rate of all the culture No.1 were zero,and there were six cases(10.7%)of positive culture No.2 in theobservation group.However,the number of positive culture No.3 in the observation group [7(12.5%)] was significantly higher than that in the control group(0)(P < 0.05),and the number of positive culture cases in the observation group [11(19.6%)] was also significantly higher than that in the control group(0)(P < 0.05).Pelvic infection had occurred in 4(7.1%)of all the 11 cases(19.6%)with positive culture in the observation group,accounting for 36.4%(4 / 11).There were no cases of postoperative wound infection,anastomotic bleeding and pulmonary infection found in both the observation group and the control group,and there were no significant differences in terms of postoperative intestinal obstruction,urinary retention and anastomotic leakage between the two groups(all P > 0.05).Four cases(7.1%)of pelvic infection had been found in the observation group,culture No.2 and No.3 was positive in 2 patients,respectively,and there was no significant difference compared with the control group(0)(P > 0.05).Conclusions: Laparoscopic transanal total mesorectal excision(Lap-taTME)was more prone to happen intraoperative contamination than laparoscopic total mesorectal excision(Lap-TME),but did not significantly increase the risk of postoperative pelvic infection.Positive effusion bacterial culture during Laparoscopic transanal total mesorectal excision(Lap-taTME)suggested that the patients were prone to occur pelvic infection after operation,and should be prevented and managedactively during the perioperative period. |
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