腹腔镜右半结肠癌切除术后消化道重建的研究现状及前景  

Research status and prospects of digestive tract reconstruction after laparoscopic right hemicolectomy of colon cancer

作　　者：姚宏伟[1] 高加勒 庞凯 安勇博 张忠涛[1] Yao Hongwei;Gao Jiale;Pang Kai;An Yongbo;Zhang Zhongtao(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing Key Laboratory of Cancer Invasion and Metastasis Research,Colorectal Neoplasms Clinical Diagnosis and Treatment Research Center,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科,国家消化系统疾病临床医学研究中心,肿瘤侵袭和转移机制研究北京市重点实验室,首都医科大学结直肠肿瘤临床诊疗与研究中心,北京100050

出　　处：《中华消化外科杂志》2021年第3期255-259,共5页Chinese Journal of Digestive Surgery

基　　金：国家科技支撑计划课题(2015BAI13B09);国家重点研发计划资助(2017YFC0110904);北京市临床重点专科基金(卓越项目2018-118);北京市医院管理局临床医学发展专项基金(ZYLX201504);首都卫生发展科研重点项目(首发2018-1-1111);首都医科大学结直肠肿瘤临床诊疗与研究中心基金(1192070313);首都医科大学附属北京友谊医院科研启动基金(YYQDKT2016-5)。

摘　　要：腹腔镜右半结肠癌切除术后腹腔内吻合正逐渐成为结直肠手术领域中的热点。研究者发现:腹腔内吻合与腹腔外吻合比较,前者在促进病人术后恢复,降低术后并发症发生率等方面有潜在优势。且腹腔内吻合较腹腔外吻合病人术后胃肠功能恢复更快、术后疼痛评分更低。但对于腹腔内吻合的并发症发生率,尤其是重要指标吻合口漏的比较,尚缺乏足够证据。而手术技术不统一、吻合口漏定义不明确是目前研究的主要困难。多项高质量的前瞻性随机对照试验目前正在进行中,对于腹腔镜右半结肠癌切除术的客观评价仍需要更高级别的循证医学证据验证。笔者综合分析国内外研究进展,系统阐述腹腔镜右半结肠癌切除术后消化道重建的研究现状及前景,旨在为我国结直肠外科临床研究探索新方向。Intracorreal anastomosis in laparoscopic right hemicolectomy of colon cancer is becoming a hot spot in colorectal surgery.A number of retrospective studies ha suggested that intracorporeal anastomosis has potential advantages in promoting postoperative recovery and reducing postoperative complications compared with conventional extracorporeal anastomosis.Several randomized controlled trials published recently have also confirmed that intracorporeal anastomosis can promote postoperative gastrointestinal function recovery and reduce postoperative pain,but there is still insufficient evidence to draw a conclusion about the incidence of complications,especially the anastomotic leakage rate.Heterogeneity of surgical techniques and unclear definition of anastomotic leakage are thmain difficulties in current studies.Several high-quality prospective randomized controlled trials are currently under way,and high level of evidence is needed to objectively evaluate the laparoscopic right hemicolectomy of colon cancer.The authors review the relevant literatures at home and abroad,systematically elaborate the research status and prospects of digestive tract reconstruction after laparoscopic right hemicolectomy of colon cancer,in order to explore a new direction for the clinical research of colorectal surgery in China.

关 键 词：结肠肿瘤 腹腔镜辅助右半结肠切除术 全腹腔镜右半结肠切除术 腹腔内吻合 腹腔外吻合 

分 类 号：R735.35[医药卫生—肿瘤]