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癌症微创右半结肠切除术后体内与体外回结肠吻合术的效果:一项观察性研究

Outcomes of Intra- versus Extra-Corporeal Ileocolic Anastomosis after Minimally Invasive Right Colectomy for Cancer: An Observational Study.

作者信息

Vallribera Francesc, Kraft Miquel, Pera Meritxell, Vidal Laura, Espín-Basany Eloy

机构信息

Colorectal Surgery, Vall d'Hebron University Hospital, 08035 Barcelona, Spain.

出版信息

J Clin Med. 2021 Jan 15;10(2):307. doi: 10.3390/jcm10020307.

Abstract

Intracorporeal anastomoses (IA) are increasingly being used in colorectal surgery. Some data suggest that these might confer benefits compared with extracorporeal anastomoses (EA). The aim of this study is to compare the short-term complications associated with IA versus EA for minimally invasive right colectomy. This is a single-centre, retrospective study on a prospective database. Patients who underwent minimally invasive right colectomy for cancer between January 2017 and December 2019 were assessed for inclusion. The primary outcome was global 30-day morbidity. Overall, 189 patients were included, of whom 102 had IA. Global morbidity and medical complications were higher in patients with EA (23.5% vs. 40.2%, = 0.014; 5.9% vs. 14.9%, = 0.039, respectively). None of the patients with IA had non-infectious surgical wound complications, compared to 4.6% in the EA group ( = 0.029). No differences were found in anastomotic leakage (9.8% vs. 10.3%, = 0.55). At multivariable analysis, EA was an independent risk factor for both surgical (OR = 3.71 95% CI: 1.06-12.91, = 0.04) and overall complications (OR = 3.58 95% CI: 1.06-12.12, = 0.04). IA lowers the risk for global, medical, and surgical complications with minimum risk for wound complications, without increasing the risk of AL.

摘要

体内吻合术(IA)在结直肠手术中的应用越来越广泛。一些数据表明,与体外吻合术(EA)相比,IA可能具有优势。本研究旨在比较IA与EA用于微创右半结肠切除术的短期并发症。这是一项基于前瞻性数据库的单中心回顾性研究。对2017年1月至2019年12月期间因癌症接受微创右半结肠切除术的患者进行纳入评估。主要结局是30天总体发病率。总体而言,共纳入189例患者,其中102例行IA。EA组患者的总体发病率和医疗并发症更高(分别为23.5%对40.2%,P = 0.014;5.9%对14.9%,P = 0.039)。IA组患者均无非感染性手术伤口并发症,而EA组为4.6%(P = 0.029)。吻合口漏方面未发现差异(9.8%对10.3%,P = 0.55)。多变量分析显示,EA是手术并发症(OR = 3.71,95%CI:1.06 - 12.9;P = 0.04)和总体并发症(OR = 3.58,95%CI:1.06 - 12.12;P = 0.04)的独立危险因素。IA降低了总体、医疗和手术并发症的风险以及伤口并发症的最低风险,且未增加吻合口漏的风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/68da/7830629/3069ca489871/jcm-10-00307-g001.jpg

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