右半结肠癌根治术全腹腔镜下三步法体内吻合术与腹腔镜辅助下体外吻合术的短期疗效比较

Comparsion on short-term efficacy of three-step intracorporeal anastomosis in total laparoscopic right hemicolectomy and extracorporeal anastomosis in laparoscopic assisted right hemicolectomy

目的:探究全腹腔镜下右半结肠癌根治术(TLRC)三步法体内吻合术与腹腔镜辅助下右半结肠癌根治术(LARC)体外吻合术的短期疗效。方法:回顾性分析90例右半结肠癌患者临床资料,按不同术式分为体内吻合组(n=48,TLRC联合三步法体内吻合术治疗)和体外吻合组(n=42,LARC联合体外吻合术治疗)。比较两组围术期疼痛VAS评分、手术期指标(吻合时间、肛门通气时间、术中出血量、淋巴结清扫、住院时间等)、免疫功能指标(CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+))、应激反应指标(Cor、NE)、炎性反应指标(hs-CRP、IL-6)、肠屏障功能指标(D-乳糖、DAO及内毒素)等。结果:体内吻合组吻合时间、肛门通气时间及术中出血量均小于体外吻合组(P<0.05);体内吻合组术后1 d及3 d疼痛VAS评分均低于体外吻合组(P<0.05);体外吻合组术后血清皮质醇(Cor)、去甲肾上腺素(NE)、高敏-C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、D-乳糖、二胺氧化酶(DAO)及内毒素水平均高于体内吻合组(P<0.05);体内吻合组并发症总发生率低于体外吻合组(P<0.05)。结论:TLRC三步法体内吻合术与LARC体外吻合术均有良好根治效果,而体内吻合术可缩短吻合时间,减少术中出血及术后并发症发生风险,减轻手术应激反应、炎症反应及肠屏障损伤。

Objective:To explore the short-term efficacy of three-step intracorporeal anastomosis in total laparoscopic right hemicolectomy(TLRC) and extracorporeal anastomosis in laparoscopic assisted right hemicolectomy(LARC).Methods:The clinical case data of 90 patients with right-sided colon cancer were retrospectively analyzed.According to different surgical methods, the patients were divided into intracorporeal anastomosis group(n=48,TLRC combined with three-step intracorporeal anastomosis) and extracorporeal anastomosis group(n=42,LARC combined with extracorporeal anastomosis).The VAS score of perioperative pain, surgical indicators(anastomotic time), anal ventilation time, intraoperative bleeding, lymph node dissection, hospitalization time,immune function indicators(CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)),stress response indicators [serum cortisol(Cor),norepinephrine(NE)],inflammatory response indicators [high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6)],intestinal barrier function indicators [D-lactose, diamine oxidase(DAO),endotoxin] were compared between the two groups.Results:The anastomosis time, anal ventilation time and intraoperative blood in intracorporeal anastomosis group were less than those in extracorporeal anastomosis group(P<0.05).The pain VAS scores in intracorporeal anastomosis group at 1 and 3 d after surgery were lower compared with those in extracorporeal anastomosis group(P<0.05).The levels of Cor, NE, high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),D-lactose, DAO and endotoxin in intracorporeal anastomosis group were higher than those in extracorporeal anastomosis group(P<0.05).The total incidence of complications in intracorporeal anastomosis group was lower than that in extracorporeal anastomosis group(P<0.05).Conclusion:Three-step intracorporeal anastomosis in TLRC and extracorporeal anastomosis in LARC both have good radical effects, but intracorporeal anastomosis can significantly shorten the anastomosis time, reduce the risk of intraoperative blood loss and postoperative complications, and reduce the surgical stress reaction, inflammatory reaction and intestinal barrier damage.