腹腔镜右半结肠切除术回结肠端侧吻合和侧侧吻合对术后肠功能和生活质量影响对比研究

Effects of end-side and side-side anastomosis following a laparoscopic right hemicolectomy on postoperative intestinal function and quality of life

目的比较腹腔镜右半结肠切除术行回结肠端侧吻合和侧侧吻合对病人术后肠功能及生活质量的影响。方法采用回顾性队列研究方法,收集2022年6月至2023年6月南京鼓楼医院结直肠外科收治的右半结肠癌行腹腔镜右半结肠切除术病人的临床资料。根据回结肠吻合方式的不同,分为端侧吻合组(31例)及侧侧吻合组(64例)。通过术后首次通气时间、术后首次通便时间、腹泻症状和持续时间评估病人术后肠功能,通过胃肠生活质量评分(GIQLI)评价病人术后生活质量,比较两组病人术后肠功能及生活质量的差异。结果两组病人年龄、性别、体重指数、术后病理分期、美国麻醉医师协会分级、术中出血量、清扫淋巴结数、术后并发症发生率和住院时间差异无统计学意义(P>0.05)。端侧吻合组术后首次通气时间[4.0(3.85,4.35)d vs.3.6(3.40,3.725)d]和首次通便时间[4.5(4.30,4.80)d vs.4.1(4.00,4.30)d]晚于侧侧吻合组,差异有统计学意义(P<0.001)。端侧吻合组术后每日腹泻次数[4(3,4)次/d vs.5(4,6)次/d]和术后腹泻持续天数[3.0(2.0,4.0)d vs.4.5(4.0,6.0)d]低于侧侧吻合组,差异有统计学意义(P<0.05)。端侧吻合组术后2周、1个月和3个月的GIQLI评分分别为69.0(65.50,73.50)分、99.0(93.00,100.00)分和110.0(106.50,117.50)分,侧侧吻合组分别为63.0(61.00,67.00)分、76.5(72.50,81.50)分和104.0(96.75,109.25)分,端侧吻合组各时间点GIQLI评分均高于侧侧吻合组,差异有统计学意义(P<0.001)。结论与侧侧吻合相比,端侧吻合可能更有助于改善右半结肠癌病人的术后肠功能和生活质量。

Objective To compare the effects of end-side anastomosis(ES)and side-side anastomosis(SS)following laparoscopic right hemicolectomy on postoperative intestinal function and quality of life in patients with right colon cancer.Methods A retrospective cohort study was conducted using the clinical data of patients with right colon cancer who underwent laparoscopic right hemicolectomy at Nanjing Drum Tower Hospital from June 2022 to June 2023.Patients were divided into two groups based on the anastomosis technique:the ES group(31 cases)and the SS group(64 cases).Postoperative intestinal function was assessed by the time to first flatus,time to first defecation,and the frequency and duration of diarrhea.Quality of life was evaluated using the Gastrointestinal Quality of Life Index(GIQLI).Differences in postoperative intestinal function and quality of life between the two groups were compared.Results There were no significant differences between the two groups in baseline characteristics such as age,gender,body mass index,postoperative pathological stage,American College of Anesthesiologists classification,intraoperative blood loss,number of lymph nodes harvested,postoperative complications,and length of hospital stay(P>0.05).The time to first flatus[4.0(3.85,4.35)d vs.3.6(3.40,3.725)d]and the time to first defecation[4.5(4.30,4.80)d vs.4.1(4.00,4.30)d]in the ES group were significantly later than those in the SS group,and the difference was statistically significant(P<0.001).Postoperative daily diarrhea frequency[4(3.0,4.0)times/d vs.5(4,6)times/d]and postoperative diarrhea duration[3(2.0,4.0)d vs.4.5(4.0,6.0)d]in ES group were lower than those in SS group,and the difference was statistically significant(P<0.05).The GIQLI scores of the ES group at 2 weeks,1 month,and 3 months postoperatively were 69.0(65.50,73.50)points,99.0(93.00,100.00)points and 110.0(106.50,117.50)points,respectivel.The GIQLI scores of the SS group 63.0(61.00,67.00)points,76.5(72.50,81.50)points,and 104.0(96.75,109.25)points.The CIQLI scores in the ES group were higher than those in the SS group at all time points,with statistical significance(P<0.001).Conclusion ES may be more beneficial than SS in improving postoperative intestinal function and quality of life in patients undergoing laparoscopic right hemicolectomy for right colon cancer.