应用重叠式三角吻合技术的3D完全腹腔镜右半结肠切除术的近期疗效分析

The short-term results analysis of overlapped delta-shaped anastomosis in 3D totally laparoscopic right hemicolectomy

目的比较应用重叠式三角吻合技术的3D与2D完全腹腔镜右半结肠切除术的近期疗效资料,探讨重叠式三角吻合技术在3D完全腹腔镜右半结肠切除术中的可行性和安全性。方法回顾性分析中国医学科学院北京协和医学院肿瘤医院2017年5月至2018年10月收治的67例右半结肠恶性肿瘤患者的资料,其中行2D完全腹腔镜右半切除术的患者35例,设为2D组;行3D完全腹腔镜右半切除术的患者32例,设为3D组。对比其手术及术后恢复情况、病理情况以及围手术期并发症等。结果两组之间,3D组手术时间、消化道重建时间明显小于2D组(均P<0.05),但术中出血量、手术切口长度差异无统计学意义(P>0.05)。两组患者术后行走时间、排气时间、排便时间、术后住院时间差异无统计学意义(均P>0.05)。两组在肿瘤大小、远近切缘距离、淋巴结清扫数目、肿瘤TNM分期等方面,差异无统计学意义(P>0.05)。两组术后并发症发生率分别为6.2%和5.7%,差异亦无统计学意义(P=0.928)。结论重叠式三角吻合技术在3D完全腹腔镜右半结肠切除术切实可行,安全可靠,具有满意的近期疗效。与2D腹腔镜手术相比,在3D腹腔镜下可明显缩短手术时间和消化道重建时间。

Objective This study aims to explore the safety,feasibility and short-term results of overlapped delta-shaped anastomosis in 3 D totally laparoscopic right hemicolectomy.Methods From May 2017 to October 2018,a total of 32 and 35 patients who underwent overlapped delta-shaped anastomosis in 3 D and 2 D total laparoscopic right hemicolectomy were respectively selected.Data regarding surgical outcomes,postoperative recovery,pathological outcomes and complications were collected and compared.Results Between the two groups,the operative time and anastomosis time of the 3 D group were significantly less than those of the 2 D group(all P<0.05),but there was no significant difference in intraoperative blood loss and length of incision(P>0.05).The time to ground activities,first flatus time,first defecation time and postoperative hospitalization did not differ between the two groups(all P>0.05).There was no significant difference between the two groups in tumor size,distance of proximal and distal incisional margins,number of lymph node dissection,TNM stage of the tumor,etc.(P>0.05).The incidence of postoperative complications in the two groups was 6.2%and 5.7%,respectively,with no significant difference(P=0.928).Conclusions 3 D totally laparoscopic right hemicolectomy with overlapped delta-shaped anastomosis is a safe and feasible procedure with a satisfactory short-term effect.Compared with 2 D laparoscopic surgery,3 D laparoscopy can shorten the operation time and anastomosis time significantly.