生物可降解吻合环在腹腔镜结肠癌根治术中的应用

Biofragmentable Anastomosis Ring in Laparoscopic Radical Resection for Colon Cancer

目的探讨生物可降解吻合环在腹腔镜结肠癌根治术消化道重建中的应用价值。方法回顾性分析2007年1月-2010年10月31例腹腔镜结肠癌根治术应用Valtrac吻合环进行消化道重建的临床资料。其中升结肠13例,横结肠8例,降结肠6例,乙状结肠4例。腹腔镜下完成肠管及系膜游离、淋巴结清扫操作,经腹壁5-8 cm切口入腹,切除肿瘤后用生物可降解吻合环进行肠管端端吻合。结果 31例手术均获得成功,完成肠吻合时间12.5-17 m in,平均14.5 m in。术中出血20-100 m l,平均30 m l。13例行回肠-结肠吻合,吻合环直径28 mm、闭合间隙2.0 mm,18例行结肠-结肠吻合,吻合环直径31或33 mm、闭合间隙2.5 mm。未发生术后吻合口出血、吻合口漏。1例术后3个月结肠-结肠吻合口狭窄,直径约1.2cm,肠镜下扩张。术后肠功能恢复时间28-56 h,平均42.2 h。31例术后随访6-24个月,平均10个月,无肿瘤复发、远处转移及伤口种植转移。结论在腹腔镜结肠癌根治术中应用生物可降解吻合环进行消化道的重建是一种安全、微创、高效、可标准化的术式。

Objective To investigate the value of biofragmentable anastomosis ring（BAR） in alimentary tract reconstruction after laparoscopic radical resection for colon cancer.Methods The clinical data of 31 patients,who recieved intestinal anastomoses with BAR after laparoscopic radical resection for colon cancer between January 2007 and October 2010,were analyzed retrospectively.There were 13 patients with ascending colon cancer,8 with transverse colon cancer,6 with descending colon cancer,and 4 with sigmoid colon cancer.The separation of the colon and mesentery and the dissection of lymph node were performed under laparoscopy.After tumor resected through inimally-invasive abdominal wall,end-to-end anastomosis was performed using a BAR in open surgical procedure.Results The operation was completed in all of the 31 cases.The time for alimentary tract reconstruction ranged from 12.5 minutes to 17 minutes with a mean of 14.5 minutes.The mean intraoperative blood loss was 30 ml（20 ml to 100 ml）.Among the 31 cases,13 patients underwent ileocolostomy with a 28-mm BAR in diameter and 2-mm closed space;18 received colocolostomy with a 31-mm or 33-mm BAR in diameter and a closed space of 2.5 mm.None of them had anastomotic bleeding or leakage.Post-colocolostomy anastomotic stenosis（1.2 cm） occurred in one patient,who then received dilation by colonoscopy.The function of the bowel recovered in 28-56 hours with a mean of 42.2 hours.The patients were followed up for 6 to 24 months（mean,10 months）,none of them had recurrent tumor at the anastomotic site,distant metastasis or implanted metastatic lesions on the abdominal wall during the period.Conclusions Alimentary tract reconstruction with BAR after laparoscopic radical resection of colon cancer is a safe,minimally invasive,effective procedure,which can be standardized.