机器人全腔内原位回肠新膀胱术中Overlap吻合技术恢复肠道连续性的应用体会

Application of Overlap anastomosis technique to restore continuity of ileum in robotic intracorporeal orthotopic ileal neobladder

目的:介绍Overlap肠道吻合技术在机器人全腔内原位回肠新膀胱中恢复肠道连续性的手术经验和临床价值。方法:选取2019年12月-2020年10月于中国人民解放军总医院行机器人全腔内原位回肠新膀胱术且术中行Overlap吻合术共15例患者纳入研究。Overlap吻合术恢复肠道连续性的具体方法为,于离断的近端肠管对系膜缘侧距断端5~6 cm处、远端肠管对系膜缘侧距断端约0.5 cm处各剪开约1 cm切口,置入直线切割闭合器钉仓后闭合切割,并缝合肠管共同开口处。结果:所有患者均顺利完成手术,无中转开腹。相比于π式吻合,Overlap肠道吻合时间相对延长(17.6±2.1)min vs.(9.3±1.9)min(P<0.05),术后排气时间差异无统计学意义(2.7±1.1)d vs.(3.1±0.7)d(P=0.366),但术后进清流食时间明显缩短(3.2±0.7)d vs.(5.1±1.2)d(P<0.05)。所有患者均恢复良好,新膀胱功能正常,随访1~11个月,未出现尿瘘、肠瘘、吻合口狭窄等并发症。结论:Overlap吻合术应用于机器人全腔内原位回肠新膀胱术中恢复肠道连续性初步证实是安全可行的,更多的临床经验及长期的随访结果有待于进一步研究。

Objective:To summarize the surgical experience and clinical value of Overlap anastomosis technique in robotic intracorporeal orthotopic ileal neo-bladder.Methods:Totally,15 patients who underwent robotic orthotopic ileal neobladder and Overlap anastomosis in the General Hospital of the Chinese People’s Liberation Army from December 2019 to October 2020 were included in the study.During Overlap anastomosis,1 cm incisions were cut at5-6 cm away from the proximal edge to the mesentery and about 0.5 cm away from the distal edge to the mesentery respectively.The incisions were closed cut after the linear cutter was in place,and then the common opening of the intestinal tube was sutured continuously.Results:All the 15 operations were completed successfully,and no patients were converted to open surgery or ileum conduit.Time of overlap intestinal anastomosis was relatively longer thanπanastomosis[(17.6±2.1)min vs.(9.3±1.9)min(P<0.05)].There was no significant difference in bowel recovery time[(2.7±1.1)d vs.(3.1±0.7)d(P=0.366)],but the time of food intake was significantly shorter[(3.2±0.7)d vs.(5.1±1.2)d(P<0.05)].During the follow-up period of 1-11 months,all patients recovered well and there were no complications such as urinary fistula,intestinal fistula and anastomotic stricture.Conclusion:It is safe and feasible to perform overlap anastomosis in robotic intracorporeal orthotopic ileal neo-bladder.More clinical experience and long-term follow-up results are needed to be further studied.