腹腔镜右半结肠癌根治术中采用平行重叠吻合法胃肠道重建后经阴道取标本临床观察  

Application of parallel and cross-to-overlap anastomosis followed by transvaginal specimen extraction in laparoscopic radical resection of right hemicolon cancer

作　　者：王志凯 张建成 张超 温东朋 张诚 白军伟 WANG Zhi-kai;ZHANG Jian-cheng;ZHANG Chao;WEN Dong-peng;ZHANG Cheng;BAI Jun-wei(Department of Gastrointestinal Surgery,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院郑州大学人民医院胃肠外科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2022年第9期925-927,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210047)。

摘　　要：目的 观察腹腔镜右半结肠癌根治术中采用平行重叠吻合法进行胃肠道重建后经阴道取标本的效果,探讨其安全性。方法 42例右半结肠癌女性患者,均行腹腔镜下右半结肠癌根治术,16例采用平行重叠吻合法行胃肠道重建经阴道取标本者为观察组,26例常规应用管状吻合器吻合联合腹部辅助切口取标本者为对照组。比较2组年龄、肿瘤直径、临床分期等临床资料;记录2组术中吻合时间、术中出血量、术后1 d疼痛视觉模拟评分(visual analogue scale, VAS)、术后排气时间及吻合口相关并发症发生情况。结果 2组年龄、肿瘤直径、临床分期等临床资料比较差异均无统计学意义(P>0.05)。2组均于腹腔镜下完成手术。观察组术中出血量[(3.6±0.3)mL]少于对照组[(4.8±0.9)mL](t=-5.299,P<0.001),术后1 d VAS评分[(3.9±0.4)分]低于对照组[(6.4±0.8)分](t=-13.849,P<0.001),术后排气时间[(2.4±0.3)d]短于对照组[(2.9±0.3)d](t=-5.131,P<0.001),术中吻合时间[(20.4±1.9)min]与对照组[(19.7±1.4)min]比较差异无统计学意义(t=1.426,P=0.162)。观察组吻合口相关并发症发生率(6.25%)与对照组(7.69%)比较差异无统计学意义(χ^(2)=0.031,P=0.860)。结论 女性右半结肠癌患者腹腔镜右半结肠癌根治术中采用平行重叠吻合法行胃肠道重建后经阴道取标本可减少术中出血,减轻术后疼痛,促进肠道功能恢复,且不增加吻合口相关并发症发生率。Objective To observe the outcome of parallel and cross-to-overlap anastomosis for gastrointestinal reconstruction followed by transvaginal specimen extraction in laparoscopic radical resection of right hemicolon cancer, and to investigate the safety. Methods Forty-two female patients with right hemicolon cancer received laparoscopic radical resection, in which 16 patients underwent parallel and cross-to-overlap anastomosis for gastrointestinal reconstruction followed by transvaginal specimen extraction(observation group), and 26 patients underwent anastomosis using circular stapler followed by auxiliary abdominal incision specimen extraction(control group). The clinical data as the age, tumor diameter and clinical stage were compared between two groups, and the anastomosis time, volume of intraoperative blood loss, visual analogue scale(VAS) by day 1 after surgery, time to first flatus and anastomotic complications were recorded in two groups. Results There were no significant differences in the age, tumor diameter and clinical stages between two groups(P>0.05). All patients were performed laparoscopic surgeries. The intraoperative blood loss was less, the VAS score by day 1 after surgery was lower and the time to first flatus was shorter in observation group [(3.6±0.3) mL, 3.9±0.4,(2.4±0.3) d] than that in control group [(4.8±0.9) mL, 6.4±0.8,(2.9±0.3) d](t=-5.299, P<0.001;t=-13.849, P<0.001;t=-5.131, P<0.001), and there were no significant differences in the anastomosis time [(20.4±1.9) min vs.(19.7±1.4) min](t=1.426, P=0.162) and incidence of anastomotic complications(6.25% vs. 7.69%)(χ^(2)=0.031, P=0.860). Conclusion The parallel and cross-to-overlap anastomosis followed by transvaginal specimen extraction in laparoscopic radical resection of right hemicolon cancer has less intraoperative blood loss, slight postoperative pain and quick recovery of intestinal function, and does not increase the incidence of anastomotic complications.

关 键 词：右半结肠癌 女性 腹腔镜 平行重叠吻合法 经阴道取标本 

分 类 号：R735.35[医药卫生—肿瘤]