腹腔镜辅助右半结肠癌根治术不同侧侧吻合方式临床效果的对比研究

Comparative study on the clinical effect of laparoscopic-assisted radical resection of right colon cancer with different lateral anastomosis methods

目的:对比腹腔镜右半结肠癌根治术不同吻合方式的临床效果。方法:回顾分析2016年1月至2023年2月行腹腔镜右半结肠癌根治术患者的临床资料,根据肠道重建方式分为Overlap吻合组(行回结肠侧侧Overlap吻合,n=110)与π吻合组(行回结肠侧侧π吻合,n=120)。对比分析两组手术情况及术后并发症。结果:两组患者年龄、性别、糖尿病史、吸烟史、TMN分期差异无统计学意义(P>0.05),具有可比性。两组手术时间、术中出血量差异无统计学意义;Overlap吻合组术后首次通气时间[(2.1±1.66)d vs.(3.4±2.81)d,P=0.02]、排便时间[(4.2±2.33)d vs.(5.6±3.12)d,P=0.03]、进食时间[(3.6±1.37)d vs.(4.7±2.22),P=0.04]早于π吻合组;术后肠梗阻发生率低于π吻合组(6/110 vs.19/120,P=0.022),两组吻合口漏(4/110 vs.5/120)、术后出血(3/110 vs.3/120)的发生率差异无统计学意义(P>0.05)。结论:腹腔镜辅助右半结肠切除术采用Overlap侧侧吻合进行肠道重建,利于加快术后胃肠功能恢复、早期进食,降低术后肠梗阻的风险。

Objective:To compare the clinical effect of laparoscopic radical resection of right colon cancer with different anastomotic methods.Methods:A retrospective analysis was conducted on clinical data of patients diagnosed with right hemicolon carcinoma and underwent laparoscopic radical resection from Jan.2016 to Feb.2023.According to the intestinal tract reconstruction method,p atients were divided into overlap group(ileocolon side-to-side overlap anastomosis,n=110)andπanastomosis group(ileocolon side-to-sideπanastomosis,n=120).Operation conditions and postoperative complications of the two groups were comparatively analyzed.Results:There was no statistically significant difference between the two groups in age,gender,diabetes history,smoking history and TMN stage(P>0.05),indicating comparability.The operation time and intraoperative blood loss of the two groups were not statistically significantly different.The postoperative first ventilation time[(2.1±1.66)d vs.(3.4±2.81)d,P=0.02],defecation time[(4.2±2.33)d vs.(5.6±3.12)d,P=0.03]and the feeding time[(3.6±1.37)d vs.(4.7±2.22)d,P=0.04]of overlap group were earlier than those ofπanastomosis group.The incidence of postoperative ileus in overlap group was significantly lower than that inπanastomosis group(6/110 vs.19/120,P=0.022).There was no significant difference in the incidence of anastomotic leakage(4/110 vs.5/120)and postoperative bleeding(3/110 vs.3/120)between the two groups(P>0.05).Conclusions:Overlap side-to-side anastomosis for intestinal tract reconstruction after laparoscopic-assisted right colon resection can speed up the recovery of gastrointestinal function and early feeding,reduce the risk of postoperative ileus.