摘要
目的:通过对比全腹腔镜下顺蠕动侧侧吻合(Overlap吻合)与腹腔外吻合相关临床资料及短期疗效,探究腹腔内吻合在右半结肠癌根治术中的临床疗效及价值。方法:回顾性选择2021年01月至2023年12月我院胃肠与疝外科收治的腹腔镜右半结肠癌根治术患者临床资料,共计92例纳入临床研究。其中采用腹腔内Overlap吻合的患者为ICA组;采用腹腔外端侧吻合为ECA组。收集并分析两组患者临床资料,讨论全腹腔镜下Overlap吻合安全性及短期临床疗效差异。结果:纳入患者一般资料差异无统计学意义(P值>0.05)。手术资料方面,ICA组手术时间[(185.83±27.55)min;P=0.026]与吻合时间[(33.86±4.05)min;P<0.001]均显著长于ECA组,切口长度方面[(4.86±0.84)cm;P<0.001]ICA组显著短于ECA组。而术中出血、清扫淋巴结总数两组差异无统计学意义。术后康复方面,ICA组首次排气时间[(2.55±0.55)天;P=0.001]、首次进流质时间[(3.38±0.62)天;P<0.001]、下床时间[(2.71±0.55)天;P=0.006]、术后住院时间[(7.67±1.26)天;P=0.019]均优于ECA组,且ICA组术后引流量[(277.74±147.68)mL;P=0.017]显著少于ECA组。在术后第3天,ICA组疼痛VAS评分(3.19±0.77;P=0.04)低于ECA组。术后炎症指标方面,两组术后C反应蛋白、中性粒细胞-淋巴细胞比值(NLR)均无统计学差异(P值>0.05)。在手术后并发症方面,总并发症发生率、吻合口瘘、腹腔感染、腹腔出血、吻合口出血、切口感染、肺部感染、术后肠梗阻、术后胃瘫两组并无统计学差异(P值>0.05)。结论:全腹腔镜下Overlap吻合安全可行,具有术后肠道功能恢复更快、创伤更小等优势,手术疗效与传统腔镜辅助手术效果相当,且不会增加短期并发症发生率。
Objective:To explore the clinical efficacy and value of intraperitoneal anastomosis in radical resection of right colon cancer by comparing the clinical data and short-term efficacy of peristaltic side-to-side anastomosis and extraperitoneal anastomosis under total laparoscopy.Methods:Clinical data of patients who underwent laparoscopic radical resection of right colon cancer in the Department of Gastrointestinal and Hernia of our hospital from January 2021 to December 2023 were retrospectively selected,and a total of 92 cases were included in the clinical study.According to different anastomosis methods and intraoperative space,patients with intraperitoneal Overlap were classified as ICA group.External abdominal end-to-side anastomosis was used as ECA group.Clinical data of the two groups were collected and analyzed,and the differences in safety and short-term clinical efficacy of total laparoscopic Overlap were discussed.Results:There was no significant difference in the general information of the included patients(P>0.05).In terms of surgical data,the operative time[(185.83±27.55)min,P=0.026]and anastomosis time[(33.86±4.05)min,P<0.001]of ICA group were significantly longer than ECA group.Incision length[(4.86±0.84)cm,P<0.001]ICA group was significantly shorter than ECA group.There was no significant difference in the number of intraoperative bleeding and lymph nodes between the two groups(P>0.05).In terms of postoperative rehabilitation,the first exhaust time[(2.55±0.55)days,P=0.001],the first inlet time[(3.38±0.62)days,P<0.001],getting out of bed time[(2.71±0.55)days,P=0.006],postoperative hospital stay[(7.67±1.26)days,P=0.019]of ICA group were better than ECA group,and the postoperative drainage volume of ICA group[(277.74±147.68)mL,P=0.017]was significantly less than ECA group.On day 3 after surgery,pain VAS score in ICA group(3.19±0.77,P=0.04)was lower than ECA group.In terms of postoperative inflammatory indicators,there were no statistically significant differences in the levels of C-reactive protein and neutrophil to lymphocyte ratio(NLR)between the two groups(P>0.05).In terms of postoperative complications,there were no significant differences in the incidence of total complications,anastomotic leakage,abdominal infection,abdominal hemorrhage,anastomotic hemorrhage,incision infection,pulmonary infection,postoperative intestinal obstruction and postoperative gastroparesis between the two groups(P>0.05).Conclusion:Total laparoscopic Overlap is safe and feasible,and has the advantages of faster postoperative intestinal function recovery and less trauma.The surgical effect is comparable to that of traditional endoscopic-assisted surgery,and will not increase the incidence of short-term complications.
作者
胡柏庚
张哲
刘跃
孙亮
HU Baigeng;ZHANG Zhe;LIU Yue;SUN Liang(Department of Gastroenterology and Hernia,the First Affiliated Hospital of Kunming Medical University,Yunnan Kunming 650032,China)
出处
《现代肿瘤医学》
CAS
2024年第22期4329-4333,共5页
Journal of Modern Oncology
基金
云南省科技计划项目(编号:202401AY070001-241)。
关键词
右半结肠癌
腹腔内吻合
腹腔外吻合
Overlap吻合
right-sided colon cancer
intra-abdominal anastomosis
extra-abdominal anastomosis
Overlap anastomosis
