Overlap吻合法在完全腹腔镜根治性右半结肠切除术中的应用

The application of Overlap anastomosis in totally laparoscopic radical right hemicolectomy

目的探讨完全腹腔镜根治性右半结肠切除术中采用Overlap吻合法行回结肠吻合的可行性。方法回顾性分析2020年6月至2022年12月于桐乡市第一人民医院胃肠外科接受完全腹腔镜根治性右半结肠切除+Overlap法行回结肠侧侧吻合术的32例右半结肠癌患者及接受腹腔镜辅助根治性右半结肠切除+体外吻合法行回结肠端侧吻合术的30例右半结肠癌患者的临床资料,分别记录患者的手术时间、回结肠吻合时间、术中出血量、淋巴结清扫数目、切口长度、术后24 h疼痛评分、术后肛门排气时间、术后并发症和住院天数等围手术期资料。结果全部患者成功实施腹腔镜根治性右半结肠切除术。两组患者的性别、年龄、BMI指数、肿瘤部位、cTNM分期等差异无统计学意义(P>0.05)。与体外吻合组相比,Overlap吻合组的平均回结肠吻合时间稍长,但差异无统计学意义(P>0.05);两组手术时间、术中出血量、淋巴结清扫数目、术后住院天数相比差异均无统计学意义(均P>0.05);切口长度、术后24 h疼痛评分、术后肛门排气时间相比差异有统计学意义(均P<0.05)。Overlap吻合组1例患者术后出现淋巴漏,经禁食、营养等对症治疗后治愈;体外吻合组1例患者术后出现切口感染,经换药、引流后切口愈合。Overlap吻合组1例患者、体外吻合组2例患者出现术后肠梗阻,经禁食、胃肠减压、营养等对症支持治疗后治愈。两组各有1例患者术后出现肺部感染,经抗感染、化痰、雾化等治疗后好转。结论完全腹腔镜根治性右半结肠切除术中采用Overlap吻合法行回结肠吻合安全可行,切口小、疼痛轻、术后肠道功能恢复快,具有良好的临床应用前景。

Objective To investigate the feasibility of ileocolon anastomosis with Overlap method in complete laparoscopic radical right hemicolectomy.Methods A retrospective analysis was conducted on the clinical data of 32 cases of right colon cancer patients who received complete laparoscopic radical right colon resection+ileocolon lateral anastomosis by Overlap method,and 30 cases of right colon cancer patients who received laparoscopic radical right colon resection+ileocolon lateral anastomosis by vitro anastomosis in the Department of Gastrointestinal Surgery of Tongxiang First People's Hospital from June 2020 to December 2022.Perioperative data such as operation time,ileocolon anastomosis time,intraoperative blood loss,number of lymph nodes dissection,incision length,postoperative pain score 24 hours,postoperative anal exhaust time,postoperative complications and length of hospital stay were recorded respectively.Results Laparoscopic radical right hemicolectomy was successfully performed in all patients.There were no significant differences in gender,age,body mass index(BMI),tumor site and cTNM stage between the two groups(P>0.05).Compared with in the vitro anastomosis group,average ileocolon anastomosis time of the Overlap group was slightly longer,but the difference was not statistically significant(P>0.05).There was no significant difference between the two groups in operation time,intraoperative blood loss,number of lymph node dissection,postoperative hospitalization days(all P>0.05).There were significant differences in incision length,24 hours postoperative pain score and postoperative anal exhaust time(P<0.05).One patient in the Overlap group had postoperative lymphatic leakage,and was cured after symptomatic treatment such as fasting and nutrition.One patient in the vitro anastomosis group had postoperative incision infection,and the incision healed after dressing change and drainage.Postoperative intestinal obstruction occurred in one patient in the Overlap group and two patients in the vitro anastomosis group,after symptomatic supportive treatment such as fasting,gastrointestinal decompression,and nutritional support,they recovered.One patient in each group developed pulmonary infection after surgery,which improved after anti-infection,phlegm,and atomization.Conclusion Ileocolon anastomosis using Overlap method in complete laparoscopic radical right hemicolectomy is safe and feasible,with smaller incision,lighter pain and faster postoperative intestinal function recovery,which has achieved satisfactory short-term results in clinical practice and has a good clinical application prospect.