腔内顺蠕动侧侧吻合结合手工缝合在腹腔镜结肠癌根治术中应用疗效观察

Observation on clinical effects of intraperitoneal isoperistaltic side-to-side anastomosis combined with handsewn in laparoscopic radical colorectal cancer surgery

目的比较腔内顺蠕动侧侧吻合结合手工缝合与腔外吻合(EA)在腹腔镜结肠癌(回盲部癌、升结肠癌、横结肠癌、降结肠癌、乙状结肠上段癌)根治术中的临床疗效。方法回顾性分析厦门大学附属第一医院2019年4月至2020年8月期间行腹腔镜结肠癌根治术的80例病人资料。根据消化道重建方式,分为腔内吻合(IA)组37例以及EA组43例。分层分析:根据肿瘤部位,分为左侧组(结肠-结肠吻合)40例和右侧组(回肠-结肠吻合)40例。观察指标:(1)手术及术后近期恢复情况。(2)术后病理情况。(3)随访及预后生存情况。结果(1)手术及术后近期恢复情况:80例病人顺利完成腹腔镜结肠癌根治术,围手术期未出现死亡病例。IA组在辅助切口长度[3.00(2.50~8.00)cm vs.5.00(4.00~10.00)cm,P<0.001]、术后排气[3(2~10)d vs.4(2~9)d,P=0.001]、排便时间[6(4~11)d vs.8(4~15)d,P=0.017]、术后进食流质饮食时间[4(2~11)d vs.5(3~11)d,P<0.001]、术后住院时间[8(7~24)d vs.11(6~27)d,P=0.042]方面均优于EA组,但手术时间[(219.51±45.57)min vs.(177.91±50.46)min,P<0.001]较长,组间差异具有统计学意义。在出血量[50(20~200)mL vs.50(20~150)m L,P=0.502]、各围手术期血感染指标(P>0.050)、术后总体并发症发生率(16.22%vs.16.28%,P=0.994)、腹腔感染(5.41%vs.2.33%,P=0.470)和切口感染(2.70%vs.4.65%,P=0.647)发生率方面,两组间差异均无统计学意义。(2)术后病理情况:在肿瘤大小[(4.39±1.76)cm vs.(4.29±1.79)cm,P=0.242]、大体类型(P=0.816)、组织学类型(P=0.420)、阳性淋巴结清扫数[1(0~10)枚vs.0(0~29)枚,P=1.000]、T分期(P=0.380)、N分期(P=0.800)、病理分期(P=0.836)方面,两组间差异均无统计学意义。(3)随访及预后生存情况:所有病人均获得术后回访,随访时间为36~52个月,中位随访时间44个月。两组在术后化疗(72.97%vs.76.74%,P=0.698)、肿瘤复发转移(16.22%vs.16.28%,P=0.994)、生存率(97.30%vs.95.35%,P=0.650)方面差异均无统计学意义。(4)分层分析:左侧组中,左半结肠腔内吻合(IA-L)组在辅助切口长度[3.00(2.50~8.00)cm vs.5.00(4.00~5.00)cm,P<0.001]、术后排气[3(2~5)d vs.4(3~9)d,P=0.002]、排便时间[6.5(4~9)d vs.8(4~15)d,P=0.011]以及术后进食流质饮食时间[4(2~5)d vs.5(3~11)d,P<0.001]方面均优于左半结肠腔外吻合(EA-L)组,但手术时间较长[205.00(160~320)min vs.157.5(120~210)min,P<0.001],组间差异具有统计学意义。右侧组中,右半结肠腔内吻合(IA-R)组仅在辅助切口长度[3.00(2.50~5.00)cm vs.6.00(5.00~10.00)cm,P<0.001]优于右半结肠腔外吻合(EA-R)组,组间差异具有统计学意义。结论与EA相比,腔内顺蠕动侧侧吻合结合手工缝合在腹腔镜结肠癌(回盲部癌、升结肠癌、横结肠癌、降结肠癌、乙状结肠上段癌)根治术中安全可行,近远期疗效均可靠。

Objective To compare the clinical efficacy of intraperitoneal isoperistaltic side-to-side anastomosis combined with manual suturing and extracorporeal anastomosis(EA)in laparoscopic radical surgery for colon cancer(cancer of ileocecum ascending,transverse,descending,upper sigmoid colon).Methods A retrospective analysis of data from 80 patients who underwent laparoscopic radical surgery for colon cancer at the First Affiliated Hospital of Xiamen University from April 2019 to August 2020 was conducted.Patients were divided into two groups based on the method of digestive tract reconstruction:intracorporeal anastomosis(IA)group with 37 cases and EA group with 43 cases.Stratified analysis:According to the tumor site it was divided into 40 cases in the left side group(colo-colonic anastomosis)and 40cases in the right side group(ileo-colonic anastomosis).Observation indicators included:(1)perioperative and postoperative recovery(,2)postoperative pathological conditions,and(3)follow-up and prognosis.Results(1)Perioperative and postoperative recovery:All 80 patients completed laparoscopic radical surgery for colon cancer,with no deaths during the perioperative period.The IA group showed significant advantages over the EA group in auxiliary incision length[3.00(2.50-8.00)cm vs.5.00(4.00-10.00)cm,P<0.001],anal exhaust time[3(2-10)days vs.4(2-9)days,P=0.001],defecation time[6(4-11)days vs.8(4-15)days,P=0.017],initiation of liquid diet[4(2-11)days vs.5(3-11)days,P<0.001],and length of hospital stay[8(7-24)days vs.11(6-27)days P=0.042].However,the IA group had a longer operation time[(219.51±45.57)min vs.(177.91±50.46)min,P<0.001],with statistically significant differences between the groups.There were no significant differences between the groups in terms of blood loss[50(20-200)m L vs.50(20-150)mL,P=0.502],perioperative blood infection indicators(P>0.050),overall postoperative complication rates(16.22%vs.16.28%,P=0.994),intra-abdominal(5.41%vs.2.33%,P=0.470)and incisional infections(2.70%vs.4.65%,P=0.647).(2)Postoperative pathological conditions:There were no significant differences between the groups in terms of tumor size[(4.39±1.76)cm vs.(4.29±1.79)cm,P=0.242],gross type(P=0.816),histological type(P=0.420),number of positive lymph node clearances[1(0-10)vs.0(0-29),P=1.000],T stage(P=0.380),N stage(P=0.800),and pathological stage(P=0.836)(.3)Follow-up and prognosis:All patients were followed up for 36 to 52 months,with a median follow-up time of 44 months.There were no significant differences between the two groups in terms of postoperative chemotherapy(72.97%vs.76.74%,P=0.698),tumor recurrence and metastasis(16.22%vs.16.28%,P=0.994),and survival rate(97.30%vs.95.35%,P=0.650)(.4)Stratified analysis:In the left group,the IA-L group was significantly better than the EA-L group in terms of auxiliary incision length[3.00(2.50-8.00)cm vs.5.00(4.00-5.00)cm,P<0.001],anal exhaust time[3(2-5)d vs.4(3-9)d,P=0.002],defecation time[6.5(4-9)d vs.8(4-15)d,P=0.011]and initiation of liquid diet[4(2-5)d vs.5(3-11)d,P<0.001].However,the IA-L group had a longer operation time[205.00(160-320)min vs.157.5(120-210)min,P<0.001].In the right-sided group,the IA-R group only had a shorter auxiliary incision length[3.00(2.50-5.00)cm vs.6.00(5.00-10.00)cm,P<0.001]than the EA-R group with statistically significant difference.Conclusion Compared with extracorporeal anastomosis,intraperitoneal isoperistaltic side-to-side anastomosis combined with manual suturing is safe and feasible in laparoscopic radical surgery for colon cancer(cancer of ileocecum,ascending,transverse,descending,upper sigmoid colon),with reliable short-term and long-term efficacy.