腹腔镜辅助左半结肠切除术中端侧与侧侧吻合效果比较

Comparison of different anastomosis methods in laparoscopic assisted left hemicolectomy

目的比较腹腔镜辅助左半结肠切除术中消化道重建采取端侧或侧侧吻合的临床效果。方法回顾性分析2014年5月至2020年3月厦门大学附属第一医院结直肠肿瘤外科收治的105例行腹腔镜辅助左半结肠切除术的病人的临床资料。术中消化道重建行端侧吻合68例(端侧组),行侧侧吻合37例(侧侧组)。比较分析两组病人术中及术后情况,并随访观察预后相关指标。结果端侧组术中肠管切除长度短于侧侧组,且手术时间缩短,差异有统计学意义(P=0.046和0.015);两组术中出血量、术后24 h疼痛评分、首次排气时间、淋巴结清扫数、吻合口漏、吻合口狭窄、吻合口出血、粘连性肠梗阻差异无统计学意义(P>0.05),3年无瘤生存率差异亦无统计学意义(75.9%vs 72.3%,P=0.752)。结论腹腔镜辅助左半结肠切除术采用结肠端侧吻合与侧侧吻合进行消化道重建均可行,当肿瘤位置位于降结肠及降乙交界处时,端侧吻合可能减少脾曲游离的操作。

Objective To compare the clinical efficacy of end-to-side and side-to-side anastomosis in laparoscopic assisted left hemicolectomy.Methods The clinical data of 105 patients who underwent laparoscopic assisted left hemicolectomy in the First Affiliated Hospital of Xiamen University from May 2014 to March 2020 were analyzed retrospectively.According to the anastomotic method of intraoperative gastrointestinal reconstruction,68 cases in end-to-side group and 37 cases in side-to-side group.The intra-and postoperative conditions of the two groups were compared,and the survival prognosis was followed up.Results The operation time of the end-to-side group was shorter than that in the side-to-side group,the length of intestinal resection was also shorter,the difference was statistically significant(P=0.046 and P=0.015).There were no significant differences in intraoperative bleeding,pain score in 24 hours after operation,first exhaust time,number of dissected lymph nodes,anastomotic leakage,anastomotic stenosis,anastomotic bleeding and adhesive intestinal obstruction(P>0.05).There was no significant difference in the 3-year disease-free survival rate between the two groups(75.9%vs 72.3%,P=0.752).Conclusion Laparoscopic assisted left hemicolectomy is feasible to reconstruct the digestive tract with end-to-side or side-to-side anastomosis.When the tumor is located at the descending colon and the junction of the descending-sigmoid colon,end-to-side anastomosis may reduce the operation of splenic flexure dissociation.