完全腹腔镜右半结肠癌切除术两种腔内消化道重建方案对比研究

A comparative study of two endovascular digestive tract reconstruction schemes for complete laparoscopic right half colon cancer resection

目的:探究完全腹腔镜右半结肠癌切除术中两种腔内消化道重建方案的安全性和可行性。方法:回顾性分析2021年6月至2023年6月59例右半结肠癌患者的病例资料。根据消化道重建方式不同分为两组。31例患者在消化道重建行逆蠕动“T”形吻合,设为观察组;28例患者在消化道重建行顺蠕动重叠式三角吻合,设为对照组。SPSS 22.0软件统计分析数据。围手术期各项指标和血清炎症因子等计量资料以(x±s)表示,行独立样本t检验;术后并发症等计数资料,行χ^(2)检验或Fisher精确概率法分析。P<0.05为差异有统计学意义。结果:59例患者均顺利完成完全腹腔镜右半结肠癌切除术,无中转开腹。观察组患者手术时间、术中出血量、吻合时间、术后首次下床时间、首次排气时间均优于对照组,差异均有统计学意义(P<0.05);两组患者术后3d白介素6(IL-6)、肿瘤坏死因子-α(TNF-α)、干扰素-γ(INF-γ)、C反应蛋白(CRP)均较术前增加,但观察组患者均低于对照组(P<0.05);观察组患者并发症发生率低于对照组(9.6%vs.17.9%),但差异无统计学意义(P>0.05)。结论:在完全腹腔镜右半结肠癌切除术中行逆蠕动“T”形吻合法较顺蠕动重叠式三角吻合法,可明显缩短消化道重建手术时间,术后机体炎症应激水平降低,利于患者术后恢复,具有安全性和可行性,值得临床进一步推广运用。

Objective:TTo explore the safety and feasibility of two types of endovascular digestive tract reconstruction during complete laparoscopic right hemicolonectomy.Methods:Data of 59 patients with right colon cancer from June 2021 to June 2023 were retrospectively analyzed.They were divided into two groups according to different ways of digestive tract reconstruction.A total of 31 patients underwent retroperistaltic"T"anastomosis in digestive tract reconstruction and were set as observation group.28 patients underwent paracalistaltic overlapping triangular anastomosis in digestive tract reconstruction and were set as control group.SPSS 22.0 software analyzed the data statistically.Perioperative indicators and serum inflammatory factors were expressed as(x±s),and independent sample t test was performed.The statistical data of postoperative complications were analyzed byχ^(2) test or Fisher exact probability method.P<0.05 was considered statistically significant..Results:All 59 patients successfully completed complete laparoscopic resection of right colon cancer without conversion to laparotomy.The operation time,intraoperative blood loss,anastomosis time,first time to get out of bed after operation and first exhaust time in observation group were better than those in control group,with statistical significance(P<0.05).The levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),interferon-γ(INF-γ)and C-reactive protein(CRP)in 3 days after surgery were increased in both groups,but the observation group was lower than the control group(P<0.05).The incidence of complications in observation group was lower than that in control group(9.6%vs.17.9%),but the difference was not statistically significant(P>0.05).Conclusion:In the complete laparoscopic resection of right half colon cancer,the antiperistaltic“T”anastomosis method can significantly shorten the time of digestive tract reconstruction and surgery,and reduce the postoperative inflammatory stress level of the body,which is conducive to postoperative recovery of patients,and is safe and feasible,worthy of further clinical promotion and application.