回结肠端侧吻合与侧侧吻合对右半结肠癌根治术后腹泻发生的影响

Effect of end-to-side ileocolon and side-to-side ileocolon on diarrhea after radical resection of right colon cancer

目的分析比较回结肠端侧吻合与侧侧吻合对右半结肠癌根治术后腹泻发生的影响。方法收集2019年6月~2021年6月我院收治的90例右半结肠癌病人的临床资料。根据不同手术吻合方式,将病人分为A组30例,回结肠吻合采用25 mm圆形吻合器行端侧吻合,结肠残端5 cm;B组30例,回结肠吻合采用25 mm圆形吻合器行端侧吻合,结肠残端10 cm;C组30例,回结肠吻合采用75 mm直线切割闭合器行侧侧吻合。回顾性分析病人术后腹泻的危险因素及分析比较不同手术吻合方式的疗效。结果研究结果显示有35名病人出现了术后腹泻,单因素分析显示,年龄(P=0.033)、球杆比(P=0.015)、吻合方式(P=0.014)、恢复流食时间(P=0.024)、术后抗生素时间(P=0.0330)等在腹泻与非腹泻间比较,差异有统计学意义。多因素分析显示,球杆比(P=0.012,OR=0.195)是右半结肠癌术后腹泻发生的独立影响因素;A组与C组相比(P<0.01,OR=0.181)、B组与C组相比(P=0.021,OR=2.243),比较有统计学意义,而A组与B组相比(P=0.661,OR=1.339)无统计学意义,所以吻合方式也是右半结肠癌术后腹泻发生的独立影响因素。术后每日腹泻次数(P=0.028)、术后腹泻持续天数(P=0.045)、术后肠道sIgA(P=0.018)、术后血D-乳酸(P=0.019)在端侧吻合组与侧侧吻合组间都存在,差异有统计学意义。结论1.年龄、球杆比、吻合方式、恢复流食时间、术后抗生素时间等与右半结肠癌根治术后腹泻的发生有相关性。2.球杆比、吻合方式是右半结肠癌根治术后腹泻发生的独立危险因素。3.端侧吻合组比侧侧吻合组术后腹泻发生率、术后腹泻程度都要降低,其中模拟盲肠5cm与模拟盲肠10 cm对术后腹泻影响相近。4.肠道sIgA、血D-乳酸的变化可能是端侧吻合与侧侧吻合影响术后腹泻发生的机制。

Objective To analyze the effects of end-to-side ileocolon and side-to-side ileocolon on diarrhea after radical resection of right colon cancer.Methods Total 90 right colon cancer subjects from Jingzhou First People’s Hospital between June 2019 and June 2021 were recruited.According to different surgical anastomosis methods,patients were divided into group A(30 cases):ileocolonic anastomosis was performed by end-to-side anastomosis with A 25 mm circular stapler,and the colon stump was 5 cm;Group B(30 cases):ileocolonic anastomosis was performed end-to-side anastomosis with a 25 mm circular stapler,and the colon stump was 10 cm;Group C(30 cases):ileocolon anastomosis was performed side-to-side with a 75 mm linear cutter and closure device.Multivariate Logistic regression was used to analyze the risk factors of postoperative diarrhea and compare the effects of different surgical anastomosis methods.Results The results showed that 35 patients developed postoperative diarrhea,univariate analysis showed that age(P=0.033),club ratio(P=0.015),anastomosis(P=0.014),recovery time(P=0.024),postoperative antibiotic time(P=0.033)had statistical significance between diarrhea group and non-diarrhea group.Multivariate analysis showed that club ratio(P=0.012,OR=0.195)was an independent factor influencing the occurrence of diarrhea after right colon cancer.There were statistically significant differences between group A and group C(P<0.01,OR=0.181)and group B and group C(P=0.021,OR=2.243).There was no statistical significance in group A compared with group B(P=0.661,OR=1.339).Therefore,the anastomosis method is also an independent factor influencing the occurrence of postoperative diarrhea in right colon cancer.There were statistical differences in the number of postoperative daily diarrhea(P=0.028),duration of postoperative diarrhea(P=0.045),intestinal sIgA(P=0.018)and blood D-lactic acid(P=0.019)between the end-to-side anastomosis group and the side-to-side anastomosis group.Conclusion 1.Age,club ratio,anastomosis method,recovery time of liquid food and postoperative antibiotic time were correlated with the occurrence of diarrhea after right colon cancer radical resection.2.Club ratio and anastomosis were independent risk factors for diarrhea after radical resection of right colon cancer.3.The incidence and degree of postoperative diarrhea were both lower in the end-to-side anastomosis group than in the side-to-side anastomosis group,and the effects of simulated cecum 5 cm and simulated cecum 10 cm on postoperative diarrhea were similar.4.The changes of intestinal sIgA and blood D-lactic acid may be the mechanism of end-to-side anastomosis and side-to-side anastomosis affecting postoperative diarrhea.