摘要
目的探讨免器械手工吻合技术在完全腹腔镜左半结肠切除术(totally laparoscopic left colectomy, TLLC)中的安全性和可行性。方法采用回顾性队列研究方法,回顾分析内蒙古自治区人民医院胃肠外科2020年4月至2022年4月应用免器械手工吻合技术TLLC、应用吻合器完全或辅助腹腔镜左半结肠切除消化道重建的病例资料。符合入组标准的左半结肠癌患者共77例,根据消化道重建方式分为完全腹腔镜免器械手工吻合组(35例)、器械吻合组(Overlap、端对端吻合,42例)两组。统计分析腹腔镜下两种消化道重建方式患者的手术时间、吻合口并发症、腹腔感染、术后恢复情况等资料。结果两组性别、年龄、体质量指数、ASA分级、肿瘤部位、TNM分期、术前合并糖尿病和结肠不全梗阻等均差异无统计学意义(P>0.05)。两组均行R0切除,无中转开腹手术。腹腔镜下免器械手工吻合组与器械吻合组在消化道重建时间、辅助切口方面差异有统计学意义,免器械手工吻合组重建时间长于器械吻合组[(33.7±5.0)min比(27.1±4.9)min,P<0.001],辅助切口长度短于器械吻合组[(5.6±0.84)cm比(7.7±1.11)cm,P<0.001]。两组总体并发症发生率、吻合口出血、吻合口漏、吻合口狭窄、腹腔感染并发症发生率均差异无统计学意义(P>0.05);术后首次肛门排气时间和住院时间均差异无统计学意义(P>0.05)。两组并发症均经非手术治疗痊愈,无非计划手术和死亡病例。结论免器械手工吻合技术在完全腹腔镜左半结肠切除消化道重建中简便、安全、可行,可作为器械吻合的补充,但需经验丰富的腹腔镜外科医师实施。
Objective To explore the safety and feasibly of staple-free hand-sewn laparoscopic colonic anastomosis in the totally laparoscopic left hemicolectomy.Methods From Apr. 2020 to Apr. 2022, in the Department of Gastrointestinal Surgery, Inner Mongolia Autonomous Region People's Hospital, patients who underwent total laparoscopic left colectomy with staple-free hand-sewn and total laparoscopic or laparoscopic-assisted left colectomy with stapler were retrospectively analyzed. According to the method of digestive reconstruction , a total of 77 patients with left colon cancer who met the inclusion criteria were divided into two groups: staple-free hand-sewn laparoscopic colonic anastomosis group (35 cases) and staple anastomosis (Overlap, end-to-end anastomosis) group (42 cases). The operation time, anastomotic complications, abdominal infection and postoperative recovery of the two types of digestive reconstruction were statistically analyzed.Results No significant differences were founded in gender, age, BMI, ASA grade, tumor location, TNM stage, preoperative diabetes mellitus and preoperative imcomplete colon obstruction between the two groups (P>0.05). R0 resection was performed in both groups, none required conversion to open surgery. Moreover, there were statistically significant differences in digestive reconstruction time and auxiliary incision between the two groups.The reconstruction time of staple-free hand-sewn group was remarkably longer than staple anastomosis group[(33.7±5.0)minvs(27.1±4.9)min,P<0.001], The length of auxiliary incision of staple-free hand-sewn group was shorter than that of staple anastomosis group[(5.6±0.84)cmvs(7.7±1.11)cm,P<0.001]. In addition, there were no statistically significant differences in the incidence of overall complications, anastomotic bleeding, anastomotic leakage, anastomotic stenosis, and abdominal infection between the two groups(P>0.05). There was also no significant difference in the first flatus time and hospital stay(P>0.05). The complications of the two grou
作者
王举
高小平
张凤联
姜世洲
王永强
姜洪伟
Wang Ju;Gao Xiaoping;Zhang Fenglian;Jiang Shizhou;Wang Yongqiang;Jiang Hongwei(Department of Gastrointestinal Surgery,Inner Mongolia Hospital,Hohhot 010017,China)
出处
《中华腔镜外科杂志（电子版）》
2022年第6期341-346,共6页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
基金
内蒙古自治区自然科学基金项目(2022MS08062)
