重叠式三角吻合法在完全腹腔镜左半结肠切除术消化道重建中的可行性与安全性  

Feasibility and safety of overlapping triangular anastomosis in digestive tract reconstruction of totally laparoscopic left hemicolectomy

作　　者：王海荣 冯海军 刘勇峰[3] WANG Hairong;FENG Haijun;LIU Yongfeng(General Surgery Department,the People's Hospital of Wuqi County,Yan'an 717600;General Surgery Department,the People's Hospital of Yanchuan County,Yan'an 717200;General Surgery Department,Yan'an University Affiliated Hospital,Yan'an 716000,China)

机构地区：[1]吴起县人民医院普外科,陕西延安717600 [2]延川县人民医院普外科,陕西延安717200 [3]延安大学附属医院普外科,陕西延安716000

出　　处：《临床医学研究与实践》2023年第30期65-68,共4页Clinical Research and Practice

摘　　要：目的分析重叠式三角吻合法在完全腹腔镜左半结肠切除术(TLLC)消化道重建中的可行性与安全性。方法选取2019年7月至2021年7月120例行TLLC治疗的左半结肠癌患者作为研究对象,按入院先后顺序将其分为对照组(n=60,传统三角吻合法)和研究组(n=60,重叠式三角吻合法)。比较两组的手术与术后恢复指标、术后病理情况、免疫功能指标以及并发症发生情况。结果研究组的术中出血量少于对照组,吻合时间、消化道重建时间及术后首次进食时间、排便时间均短于对照组(P<0.05);两组的手术时间、切口长度以及术后住院时间无显著差异(P>0.05)。两组的肿瘤长径、近端切缘、远端切缘以及淋巴结清扫数目无显著差异(P>0.05)。术后3 d,研究组的白细胞分化抗原3阳性(CD3^(+))、白细胞分化抗原4阳性(CD4^(+))、白细胞分化抗原4阳性/白细胞分化抗原8阳性(CD4^(+)/CD8^(+))均高于对照组,白细胞分化抗原8阳性(CD8^(+))低于对照组(P<0.05)。两组的并发症总发生率无显著差异(P>0.05)。结论在TLLC手术过程中应用重叠式三角吻合法能够缩短消化道重建时间,且对患者的免疫功能影响小,有助于尽早促进康复,临床可进一步推广运用。Objective To analyze the feasibility and safety of overlapping triangular anastomosis in digestive tract reconstruction of totally laparoscopic left colectomy(TLLC).Methods A total of 120 patients with left colon cancer who underwent TLLC from July 2019 to July 2021 were selected as the research objects,and the patients were divided into control group(n=60,traditional triangular anastomosis)and study group(n=60,overlapping triangular anastomosis)according to the order of admission.The surgical and postoperative recovery indexes,postoperative pathological conditions,immune function indexes and complications were compared between the two groups.Results The intraoperative bleeding volume in the study group was less than that in the control group,and the anastomosis time,digestive tract reconstruction time,first meal time and defecation time after surgery were shorter than those in the control group(P<0.05);there were no significant differences in surgical time,incision length and postoperative hospital stay between the two groups(P>0.05).There were no significant differences in tumor length,proximal margin,distal margin and lymph node dissection between the two groups(P>0.05).At 3 d after surgery,the cluster of differentiation 3 positive(CD3^(+)),cluster of differentiation 4 positive(CD4^(+)),cluster of differentiation 4 positive/cluster of differentiation 8 positive(CD4^(+)/CD8^(+))in the study group were higher than those in the control group,while the cluster of differentiation 8 positive(CD8^(+))was lower than that in the control group(P<0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion In the process of TLLC surgery,the application of overlapping triangular anastomosis can shorten the time of digestive tract reconstruction,and has little effect on the immune function of patients,which is helpful to promote rehabilitation as soon as possible and can be further popularized in clinical practice.

关 键 词：重叠式三角吻合法 完全腹腔镜左半结肠切除术 消化道重建 免疫功能 

分 类 号：R657.1[医药卫生—外科学]