内“8”字缝合法在腹腔镜结直肠手术中的应用

Application of inner figure-of-eight suture to laparoscopic colorectal surgery

无论是腹腔镜或是开腹的结直肠手术中，肠管吻合通常是一项重要的手术步骤。尽管吻合器已广泛应用于当今各种肠道外科手术，手工缝合仍是临床工作中不可或缺的一环，吻合器吻合后常需要追加手工缝合加固，以确保吻合口的安全。内＂8＂字缝合原属于一种用于皮肤、肌腱、白线、子宫等快速缝合的单层缝合方法，我们创新性地将其运用于腹腔镜结直肠手术中的肠管吻合和加固。内＂8＂字缝合肠道吻合法吻合基本步骤如下：（1）缝合后壁时，距离一侧肠管切缘4 mm处垂直经黏膜面进针浆膜面出针，至对侧肠管相应点浆膜面进针黏膜面出针；（2）斜行45度回到同侧肠管，依此前顺序沿＂黏膜-浆膜-对侧浆膜-黏膜＂的顺序进针出针，两针间距5 mm；（3）最后在黏膜面收紧线头打结，黏膜面缝线呈＂8＂字，浆膜面显示两针缝线平行；（4）缝合前壁时同理，依照＂浆膜-黏膜-对侧黏膜-浆膜＂的顺序进针出针，＂8＂字缝合朝向黏膜面，最后在浆膜面收紧打结，浆膜面缝线平行。不刻意追求肠壁内翻，但吻合口做好后在最后检查时，如发现有对合不满意处，可在此处浆肌层缝合加固1针。2015年至今，我们共计采用内＂8＂字缝合法进行了38例肠管吻合口加固手术和24例吻合手术，对比研究显示，内＂8＂字缝合法吻合时间更短，医疗费用更低，无一例发生吻合口漏、残端漏或是出血等并发症，随访肠镜检查也未发现吻合口狭窄。我们认为，内＂8＂字缝合法具有安全和简便的优势，是一种值得推广的手工缝合方法。

Regardless of laparoscopic or open colorectal surgeries, intestinal anastomosis is usually an important operative procedure. Even if stapler is widely used in different intestinal surgery nowadays, hand sewn suture is an indispensable procedure in clinical practice, meanwhile after stapled anastomosis, additional hand sewn suture is usually performed to ensure the safety of anastomosis. The inner figure-of-eight suture is a single layer suture technique which has been widely used in skin, tendon, rectus and uterus for quick and secure approximation. We describe our innovative application of inner figure-of-eight suture technique for intestinal anastomosis and/or reinforcement after stapled anastomosis in laparoscopic colorectal surgery. Main steps of inner figure-of-eight suture for intestinal anastomosis on posterior wall are as follows： （1） At 4 mm from cut edge of bowel, needle enters vertically from one side and courses mucosa-serosa-opposite serosa-mucosa in parallel to the entry point. （2） The needle is brought back to first entry side of bowel at 45° to enter the mucosa 5 mm below the first entry point and out on opposite side mucosa horizontally. （3） Both lose ends of the suture are pulled to approximate bowel edges and knots are tied on mucosal surface, in which suture line presents figure-of-eight on mucosal surface and two parallel suture lines are seen on serosal surface. When inner figure-of-eight suture is performed on anterior wall, the procedure is similar, but needle passes from serosa-mucosa-opposite mucosa-serosa and repeated to complete the inner figure-8 suture and knots are tied on serosa. The final look is two parallel sutures at 0.5 mm in between and the figure-of-eight remains inside the lumen. We did not deliberately try to invert the bowel edges, and if anastomosis is not satisfactory at final examination, simple interrupted seromuscular suture can be carried out. From 2015 till now, we have successfully completed inner figure-of-eight sutures in 38 cases receiving intestinal anastomosis reinforcement procedure and in 24 cases receiving hand sewn anastomosis. Comparison study revealed inner figure-of-eight suture presented shorter anastomotic time and less medical cost without anastomotic leakage, stump leakage or bleeding. No anastomotic stenosis was found at enteroscopy examination during follow up. We think that inner figure-of-eight suture possesses safe and simple advantages and is a manual suture technique worthy of promotion.