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全腹腔镜下右半结肠切除术联合三步吻合器体内顺蠕动回结肠吻合术治疗结肠癌:短期疗效评估

Total laparoscopic right hemicolectomy with 3-step stapled intracorporeal isoperistaltic ileocolic anastomosis for colon cancer: An evaluation of short-term outcomes.

作者信息

Jian-Cheng Tu, Shu-Sheng Wang, Bo Zhang, Jian Fang, Liang Zhou

机构信息

Department of General Surgery, Zhangjiagang Hospital Affiliated to Soochow University, Zhangjiagang, Jiangsu Province, P.R. China.

出版信息

Medicine (Baltimore). 2016 Nov;95(48):e5538. doi: 10.1097/MD.0000000000005538.

Abstract

Laparoscopic right hemicolectomy with extracorporeal anastomosis is a widely used procedure; several authors have published their approach to intracorporeal anastomosis. In this paper, we present an approach developed by us and compare short-term outcomes with those of extracorporeal anastomosis in colon cancer patients.Retrospective review of colon cancer patients treated with laparoscopic right hemicolectomy either with intracorporeal anastomosis (TLG group) or extracorporeal anastomosis (LG group) at the Zhangjiagang Hospital Affiliated to Soochow University between January 2011 and October 2015. Operative and postoperative data are compared.Around 85 patients underwent laparoscopic hemicolectomy (56 TLG and 29 LG) during the reference period for this study. Age, gender, body mass index (BMI), stage of cancer, operation time, number of lymph nodes harvested, and length of hospital stay were comparable between the 2 groups. In the TLG group, the ileocolic anastomosis time was significantly shorter (9.9-15.5 minutes vs 13.5-18.2 minutes in LG; P < 0.001), the mean intraoperative blood loss was lower (83.2 mL [range, 56.5-100.5 mL] vs 93.3 mL [range, 75.8 - 110.3 mL]; P < 0.001), the recovery of bowel function was faster (P < 0.001), and the postoperative pain score was lower (P < 0.001) as compared to that in the LG group. Complications in the LG group included wound infection (4 patients), obstruction (1), and postoperative bleeding complications (1); however, only 1 patient developed complication (wound infection) in the TLG group.Total laparoscopic right hemicolectomy with 3-step stapled intracorporeal anastomosis for colon cancer is a safe and reliable procedure. Its advantages include short anastomosis time, less intraoperative blood loss, less postoperative pain, and early bowel function recovery.

摘要

腹腔镜右半结肠切除术加体外吻合术是一种广泛应用的手术方式;已有多位作者发表了他们进行体内吻合术的方法。在本文中,我们介绍我们所开发的一种方法,并比较结肠癌患者体内吻合术与体外吻合术的短期疗效。对2011年1月至2015年10月期间在苏州大学附属张家港医院接受腹腔镜右半结肠切除术(体内吻合术(TLG组)或体外吻合术(LG组))治疗的结肠癌患者进行回顾性分析。比较手术和术后数据。在本研究的参考期间,约85例患者接受了腹腔镜半结肠切除术(56例TLG组和29例LG组)。两组患者的年龄、性别、体重指数(BMI)、癌症分期、手术时间、清扫淋巴结数目及住院时间相当。TLG组回结肠吻合时间显著更短(9.9 - 15.5分钟,LG组为13.5 - 18.2分钟;P<0.001),术中平均失血量更低(83.2 mL[范围56.5 - 100.5 mL],LG组为93.3 mL[范围75.8 - 110.3 mL];P<0.001),肠功能恢复更快(P<0.001),术后疼痛评分更低(P<0.001)。LG组的并发症包括伤口感染(4例患者)、肠梗阻(1例)和术后出血并发症(1例);然而,TLG组仅1例患者出现并发症(伤口感染)。采用三步吻合器体内吻合术的全腹腔镜右半结肠切除术治疗结肠癌是一种安全可靠的手术方式。其优点包括吻合时间短、术中失血少、术后疼痛轻及肠功能恢复早。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6f2/5268012/ef8a018bdd80/md-95-e5538-g001.jpg

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