Surgery Department, Vsetin Hospital, Vsetin, Czech Republic.
Surg Technol Int. 2022 May 19;40:140-146. doi: 10.52198/22.STI.40.CR1529.
The passage of flatus and stool, as well as tolerating a solid diet, represents a crucial moment in recovery after colonic resections. The present study compares functional recovery after left and right colectomies for colon cancer.
This is a retrospective analysis. Consecutive patients with elective left and right colon resections were examined. Primary analysis compared time to first bowel motion and development of postoperative ileus. Secondary analyses tried to define risk factors for prolonged restoration of bowel function in right- and left-sided resection groups.
In total, 147 patients were included. While laparoscopic approach was preferred for both sides (87% vs. 87%; p=0.496), left colectomies took longer (183 vs. 153 min; p=0.012), the lymph node harvest was smaller (16 vs. 20; p=0.005), and there was an increased need for perioperative fluids (4451 vs. 4039ml; p=0.006). Epidural use, postoperative potassium level, and glycemia were similar. Also, no significant differences were observed for complications and length of stay. First flatus was observed at postoperative day 1, 9 (left), and 2.5 (right), respectively (p=0.002). There was no significant difference in passage of first stool and intake of first solid food. Twenty-seven patients (35%) needed a postoperative nasogastric tube after right colectomy compared to 11 patients (16%) after left colectomy (p=0.012). Right-sided colectomies required the tube for longer (6.1 vs. 3.4; p=0.005).
Postoperative ileus was more frequent after right-sided colectomies despite shorter operative time. The reason for this finding is currently unknown and deserves further attention. For the time being, we can just be more cautious with early feeding after right colectomy.
排气和排便以及耐受固体饮食是结肠切除术后恢复的关键时刻。本研究比较了左、右结肠癌切除术后的功能恢复情况。
这是一项回顾性分析。连续检查了接受左、右结肠切除术的择期患者。主要分析比较了首次排便时间和术后肠梗阻的发生。次要分析试图确定左右侧切除组中恢复肠道功能时间延长的危险因素。
共纳入 147 例患者。腹腔镜手术虽然在左右两侧都更受欢迎（87%比 87%；p=0.496），但左结肠切除术时间更长（183 分钟比 153 分钟；p=0.012），淋巴结清扫量更小（16 个比 20 个；p=0.005），围手术期液体需要量增加（4451 毫升比 4039 毫升；p=0.006）。硬膜外使用、术后血钾水平和血糖相似。并发症和住院时间也无显著差异。首次排气分别在术后第 1、9（左）和 2.5 天（右）观察到（p=0.002）。首次排便和首次固体食物摄入无显著差异。27 例（35%）右结肠切除术后需要术后鼻胃管，而 11 例（16%）左结肠切除术后需要（p=0.012）。右结肠切除术后需要管的时间更长（6.1 天比 3.4 天；p=0.005）。
尽管右半结肠切除手术时间更短，但术后肠梗阻更常见。目前还不清楚造成这种结果的原因，需要进一步关注。目前，我们只能在右半结肠切除术后更谨慎地进行早期喂养。
