Schabl Lukas, Schredl Philipp, Dermuth Florentina, Bogusch Ruth, Kessler Hermann, Ramspott Jan Philipp, Emmanuel Klaus, Jäger Tarkan, Presl Jaroslav
Department for General Surgery, University Hospital of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
Updates Surg. 2025 Aug;77(4):1019-1027. doi: 10.1007/s13304-025-02159-4. Epub 2025 May 13.
When performing left hemicolectomies, surgeons might encounter difficulties when restoring bowel continuity. Ileocecal valve resection and performing an ileosigmoid anastomosis is one possible solution. An alternative is preserving the ileocecal valve by counterclockwise rotation of the remaining colon, ensuring a tension-free anastomosis. This study compares functional outcomes after Deloyers procedure and extended right colectomy with an ileosigmoid anastomosis.
Between 2008 and 2021, we included patients who underwent Deloyers procedure. Using propensity score matching, controls who underwent extended right hemicolectomy were identified. Perioperative outcomes were compared and patients were questioned using the St. Marks-score and the EORTC-29CR.
We identified 19 patients who underwent the Deloyers procedure and 28 controls. Both groups had comparable mean age (61.4 years, p = 0.3), gender distribution (women: 40%, p = 0.19), ASA classification (p = 0.89) and BMI (26.8 kg/m, p = 74). Deloyers patients were less often treated for oncologic indications (53% vs. 86%, p = 0.02). Postoperative morbidity (37% vs. 36%, p = 0.99) and mortality (0 vs. 4%, p = 0.99) were similar. Deloyers patients reported worse body perception (83.3 vs. 100, p = 0.02), but frequency of bowel movements (2 vs. 3, p = 0.09) and use of antimotility agents (8% vs. 0%, p = 0.22) were comparable. The overall and individual results of the St. Marks and EORTC QLQ-CR29 questionnaires showed no significant differences (p > 0.05).
In our study, patients who underwent Deloyers procedure showed no mortality and comparable morbidity, functional and quality of life outcomes to patients who underwent extended right hemicolectomy.
在进行左半结肠切除术时，外科医生在恢复肠道连续性方面可能会遇到困难。切除回盲瓣并进行回肠乙状结肠吻合术是一种可能的解决方案。另一种方法是通过剩余结肠的逆时针旋转保留回盲瓣，确保无张力吻合。本研究比较了德洛耶斯手术（Deloyers procedure）和扩大右半结肠切除术加回肠乙状结肠吻合术后的功能结果。
在2008年至2021年期间，我们纳入了接受德洛耶斯手术的患者。采用倾向评分匹配法，确定接受扩大右半结肠切除术的对照组。比较围手术期结果，并使用圣马克评分（St. Marks-score）和欧洲癌症研究与治疗组织生活质量问卷29项核心量表（EORTC-29CR）对患者进行询问。
我们确定了19例接受德洛耶斯手术的患者和28例对照组。两组的平均年龄（61.4岁，p = 0.3）、性别分布（女性：40%，p = 0.19）、美国麻醉医师协会（ASA）分级（p = 0.89）和体重指数（BMI，26.8kg/m²，p = 0.74）具有可比性。接受德洛耶斯手术的患者因肿瘤适应症接受治疗的频率较低（53%对86%，p = 0.02）。术后发病率（37%对36%，p = 0.99）和死亡率（0对4%，p = 0.99）相似。接受德洛耶斯手术的患者身体感知较差（83.3对100，p = 0.02），但排便频率（2次对3次，p = 0.09）和使用抗动力药物的情况（8%对0%，p = 0.22）具有可比性。圣马克问卷和EORTC QLQ-CR29问卷的总体和个体结果均无显著差异（p > 0.05）。
在我们的研究中，接受德洛耶斯手术的患者与接受扩大右半结肠切除术的患者相比，死亡率无差异，发病率、功能和生活质量结果相当。
