腹腔镜右半结肠切除术消化道重建方式的临床研究

Reconstruction of digestive tract after laparoscopic right hemicolectomy

目的比较分析腹腔镜下右半结肠切除术回肠结肠侧侧吻合术与辅助切口回肠结肠端侧吻合术患者的近期疗效资料,探讨全腹腔镜下回肠结肠侧侧吻合术的安全可行性及临床价值。方法回顾性分析解放军总医院2019年5月至2021年5月期间采用腹腔镜下右半结肠切除术的79例患者临床资料,其中全腹腔镜下回肠结肠侧侧吻合术患者30例(实验组),辅助切口回肠结肠端侧吻合术患者49例(对照组)。比较分析两组患者的一般资料,术中及术后临床资料等。结果两组患者的一般资料、术中出血量差异均无统计学意义(P>0.05);实验组切口长度[(5.53±0.73)cm]相比对照组切口长度[(7.12±1.32)cm]差异有统计学意义(P<0.05);实验组术后首次排气时间[(2.6±0.5)d]、术后疼痛程度[(3.1±0.7)分]相比对照组的[(3.5±0.7)d]、[(3.8±0.9)分]差异有统计学意义(P<0.05);对照组术后切口感染率(8.2%)较实验组术后切口感染率(0)明显升高;两组患者术后其他并发症发生率差异无统计学意义(P>0.05)。结论在腹腔镜下右半结肠切除术中应用全腹腔镜下回肠结肠侧侧吻合术具有较好近期疗效,快捷方便且安全可行,具有一定的临床应用价值。

Objective The aim of this study is to compare the short-term efficacy of laparoscopic right hemicolectomy with full endoscopic ileocolon-side-to-side anastomosis and auxiliary incision ileocolon-end-to-side anastomosis.The safety,feasibility and clinical value of complete laparoscopic side-to-side anastomosis of the lower ileocolic colon will be analyzed as well.Methods The clinical data of 79 patients who underwent laparoscopic right hemicolectomy in the General Hospital of PLA from May 2019 and May 2021 were analyzed retrospectively,30 of which underwent lateral anastomosis of the lower ileocolon under complete laparoscope(experimental group).The rest of cases were treated with end-to-side anastomosis of auxiliary incision(control group).The general data,intraoperative and postoperative clinical data of the two groups were compared.Results There was no significant difference in general data and intraoperative blood loss between the two groups(P>0.05).The incision length of the experimental group was significantly shorter than that of the control group([5.53±0.73]cm vs[7.12±1.32]cm,P<0.05).Compared with the control group,there were statistically significant differences in the first postoperative exhaust time([2.6±0.5]d vs[3.5±0.7]d)and postoperative pain degree([3.1±0.7]score vs[3.8±0.9]score,P<0.05).The postoperative wound infection rate in the control group was significantly higher than that of the experimental group(8.2%vs 0).There was no significant difference in the incidence of other postoperative complications between the two groups(P>0.05).Conclusions Complete laparoscopic lateral anastomosis of the lower ileocolon has a good short-term effect in laparoscopic right hemicolectomy with high safety and feasibility,which has clinical application value.