Pi Feng, Peng Xudong, Xie Chaozheng, Tang Gang, Qiu Yuhao, Chen Zhenzhou, Wei Zhengqiang
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Surg. 2023 Jan 5;9:1064377. doi: 10.3389/fsurg.2022.1064377. eCollection 2022.
For laparoscopic right hemicolectomy, the intermediate approach is commonly employed. However, this approach possesses several disadvantages. In this study, we compare priority access to the small bowel mesentery and the intermediate approach.
The clinical data of 196 patients admitted to the First Hospital of Chongqing Medical University for laparoscopic right hemicolectomy from January 2019 to January 2022 were retrospectively collected and divided into the small bowel mesenteric priority access and traditional intermediate access groups. The operative time, intraoperative bleeding, number of lymph node dissection, postoperative anal venting time, toleration of solid and liquid intake, and postoperative hospital stay and complications were compared between the two different approaches.
In total, 81 cases of small bowel mesenteric priority access and 115 cases of intermediate approach for right hemi-colonic radical resection were compared. The operative time was 191.98 ± 46.05 and 209.48 ± 46.08 min in the small bowel mesenteric priority access and intermediate access groups, respectively; the difference was statistically significant. There were no significant differences in the intraoperative bleeding and lymph node clearance. However, the scatter plot analysis showed that severe intraoperative bleeding was relatively less frequent in the small mesenteric priority access group, compared with that in the intermediate approach group. Additionally, there were no statistically significant differences in the first exhaust and defecation times, hospital stay after operation, toleration of solid and liquid intake, and postoperative complication between the two groups.
In laparoscopic right hemicolectomy, the small bowel mesenteric priority approach can significantly shorten the operation time compared with the intermediate approach. It can reduce intraoperative bleeding and the operation is simple and safe to perform, making it suitable for less experienced surgeons. Therefore, the small bowel mesenteric priority approach has the potential to be a suitable alternative and deserves further clinical promotion and application.
对于腹腔镜右半结肠切除术，通常采用中间入路。然而，这种入路存在几个缺点。在本研究中，我们比较了优先进入小肠系膜入路和中间入路。
回顾性收集2019年1月至2022年1月在重庆医科大学附属第一医院接受腹腔镜右半结肠切除术的196例患者的临床资料，并分为小肠系膜优先进入组和传统中间入路组。比较两种不同入路的手术时间、术中出血、淋巴结清扫数量、术后肛门排气时间、固体和液体摄入耐受性、术后住院时间及并发症。
共比较了81例小肠系膜优先进入右半结肠根治性切除术和115例中间入路病例。小肠系膜优先进入组和中间入路组的手术时间分别为191.98±46.05和209.48±46.08分钟；差异具有统计学意义。术中出血和淋巴结清除方面无显著差异。然而，散点图分析显示，与中间入路组相比，小肠系膜优先进入组严重术中出血相对较少。此外，两组在首次排气和排便时间、术后住院时间、固体和液体摄入耐受性及术后并发症方面无统计学显著差异。
在腹腔镜右半结肠切除术中，与中间入路相比，小肠系膜优先入路可显著缩短手术时间。它可减少术中出血，手术操作简单且安全，适合经验较少的外科医生。因此，小肠系膜优先入路有可能成为一种合适的替代方法，值得进一步临床推广应用。
