重叠式三角吻合法在完全腹腔镜右半结肠癌切除术中的应用  

Application of overlapped delta-shaped anastomosis technique in totally laparoscopic right hemicolectomy

作　　者：王雪玮 王鹏 洪军[2] 苏昊 梁建伟 王锡山 刘骞 周海涛 周志祥 Wang Xuewei;Wang Peng;Hong Jun;Su Hao;Liang Jianwei;Wang Xishan;Liu Qian;Zhou Haitao;Zhou Zhixiang(Department of Colorectal Surgery,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of General Surgery,Huashan Hospital of Fudan University,Shanghai 200040,China)

机构地区：[1]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院,北京协和医学院肿瘤医院结直肠外科,北京100021 [2]复旦大学附属华山医院普通外科,上海200040

出　　处：《中华胃肠外科杂志》2018年第11期1249-1254,共6页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨在完全腹腔镜右半结肠癌切除术中采用重叠式三角吻合法进行消化道重建的安全性及可行性。方法采用回顾性队列研究方法,分析2016年1月至2017年12月于中国医学科学院北京协和医学院肿瘤医院采用重叠式三角吻合法(重叠式三角吻合组)及传统改良三角吻合法(改良三角吻合组)行完全腹腔镜右半结肠切除术的患者临床资料。病例纳入标准:(1)术前均由肠镜活检明确诊断为腺癌;(2)肿瘤位于升结肠或横结肠肝区行右半切除术。排除标准:(1)结直肠双原发或多原发癌;(2)伴完全或不完全性肠梗阻;(3)需同期行联合脏器切除;(4)伴有不可切除的远处转移。重叠式三角吻合法是先将回肠末端肠管与横结肠重叠约8cm,在回肠闭合处对系膜侧及对应横结肠对系膜侧肠管开孔做吻合,再闭合共同开口:改良三角吻合法则是回肠及横结肠均在闭合处对系膜侧开孔做吻合,再闭合共同开口。运用SPSS 24.0软件统计分析并比较患者的一般信息、手术及病理结果、术后并发症情况。结果本研究共纳入108例患者,其中重叠式三角吻合组患者52例,男性28例,女性24例,年龄(53.3±10.0)岁,体质指数(BMI)为(24.2±2.7)kg/m^2。改良三角吻合组患者56例,男性27例,女性29例,年龄(54.5±9.4)岁,BMI为(23.8±2.4)kg/m^2。两组患者在年龄、性别、BMI、既往腹部手术史、美国麻醉医师学会评分、肿瘤位置、病理TNM分期、淋巴结清扫数目等基线资料方面比较,差异无统计学意义(均P>0.05)。两组所有患者均获得R0切除,无中转开腹及转为腹腔外吻合患者。重叠式三角吻合组吻合耗时明显短于改良三角吻合组[(15.7±2.3)min比(18.6±3.6)min],差异有统计学意义(t=5.017,P<0.001)。重叠式三角吻合组与改良三角吻合组患者在总手术时间[(160.7±17.8)min比(163.2±17.6)min]、术中出血量[(77.7±28.3)ml比(75.9±31.8)ml]、手术切口长度[(5.8±1.1)cm比(5Objective To explore the safety and feasibility of the overlapped delta-shaped anastomosis (ODA)technique for cases undergoing totally laparoscopic right hemicolectomy (TLRH). Methods Clinical data of patients who underwent TLRH using the ODA technique or the modified delta-shaped anastomosis (MDA)technique at Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from January 2016to December 2017were retrospectively analyzed. Inclusion criteria:(1)diagnosed with adenocarcinoma by enteroscopy before operation;(2)cancer locating at ascending colon or transverse colon hepatic region and receiving TLRH surgery.Exclusion criteria:(1)double or multiple primary colorectal cancers;(2)with complete or incomplete intestinal obstruction;(3)combined multiple organs resection;and (4)with unresectable distant metastases.The ileum and the transverse colon were sutured in an overlapped fashion about 8cm .away from the end of the ileum firstly,and then two small openings locating at the end of ileum and the corresponding site of the transverse colon were created in the ODA procedure,and the two small openings both locating at the end of ileum and the transverse colon were created in the MDA procedure.Statistical analysis was performed using SPSS 24.0software and the general information,surgical and pathological results,and complications between two groups were compared.Results A total of 108patients were enrolled in this study,including 52patients in the ODA group and 56patients in the MDA group.In the ODA group,28patients were male and 24were female with age of (53.3±10.0)years and body mass index (BMI)of (24.2±2.7)kg/m^2. In the MDA group,27patients were male and 29were female with a mean age of (54.5±9.4)years and body mass index of (23.8±2.4)kg/m2.There were no significant differences between the two groups in terms of age,gender,BMI,history of previous abdominal surgery,scoring of American Society of Anesthesiologists,tumor location,pathological TNM stage,and number of dissected lymph node

关 键 词：结肠肿瘤 右半结肠切除术 完全腹腔镜 重叠式三角吻合法 安全性 

分 类 号：R735.35[医药卫生—肿瘤]