无褶皱吻合技术治疗结直肠恶性梗阻的应用价值  

The clinical value of modified foldless anastomosisin the treatment of malignant colorectal obstruction

作　　者：王娟[1] 武广海 张帅[1] 李超[1] 徐靖[1] WANG Juan;WU Guanghai;ZHANG Shuai(Tianjin Key Laboratory of General Surgery in Construction,Department of General Surgery,Tianjin People′s Hospital,Tianjin 300121,China)

机构地区：[1]天津市人民医院天津市普通外科学重点建设学科实验室天津市人民医院普通外科,天津300121

出　　处：《腹腔镜外科杂志》2024年第1期48-51,共4页Journal of Laparoscopic Surgery

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-058B);天津市自然科学基金(21JCYBJC01070);北京科创医学发展基金(KC2021-JX-0186-93);天津市人民医院院内课题(2020YJ003)。

摘　　要：目的:探讨结直肠吻合新技术无褶皱吻合术治疗结直肠恶性梗阻的应用价值。方法:收集2020年1月至2022年12月收治的54例左半结肠直肠癌合并结直肠梗阻患者的临床资料。患者均为急诊就诊,确诊结直肠梗阻且腹部CT测量扩张肠管直径>30 mm。急症行内镜下经肛肠道自膨式金属支架置入术,术中取活检,病理结果证实恶性肿瘤。限期行腹腔镜结直肠癌切除术,术中应用无褶皱吻合技术进行一期吻合。术后随访7~24个月,评估吻合口相关并发症情况。结果:54例均完成腹腔镜结直肠癌切除术。术中测量近端肠管直径29.50~45.80 mm,平均(36.29±4.51)mm;远端肠管直径19.50~32.60 mm,平均(24.93±4.19)mm。近远端肠管管径不一致,行无褶皱吻合术,吻合放置抵钉座时间3~5 min,平均(3.80±0.79)min。术后无吻合口出血、狭窄、漏等并发症发生,术后随访未发生局部复发等远期并发症。结论:无褶皱吻合技术应用于结直肠恶性梗阻支架置入术后吻合确切,手术安全、可靠。Objective:To introduce a new technique of foldless anastomosis and evaluate its effect in the treatment of malignant colorectal obstruction.Methods:Clinical data were collected from 54 patients with left colorectal cancer complicated with colorectal o bstruction from Jan.2020 to Dec.2022.All patients were diagnosed as colorectal obstruction with dilated intestine in the emergency d epartment,and the diameter of the dilated intestinal lumen was more than 30 mm measured by abdominal CT.Emergency endoscopic transanal self-expanding metallic stent placement was performed for all enrolled patients.During the operation,biopsy was taken to confirm malignant tumor through pathology.Laparoscopic resection of colorectal cancer was performed within a limited time,utilizing the foldless anastomosis technique for one-stage anastomosis.Anastomotic complications were evaluated through a follow-up period of 7-24 months.Results:All 54 patients successfully underwent laparoscopic resection of colorectal cancer.According to the measured data d uring the operation,the proximal bowel diameter ranged from 29.50 to 45.80 mm,with a mean of(36.29±4.51)mm,while the distal bowel diameter ranging from 19.50 to 32.60 mm,with a mean of(24.93±4.19)mm.The diameters of proximal and distal intestinal c anal were inconsistent.Foldless anastomosis was performed,the anvil pla cement time ranged from 3 to 5 min,with an average of(3.80±0.79)min.No postoperative complications such as anastomotic bleeding,stenosis,anastomotic leakage occurred,and there were no long-term complications of local recurrence during the follow-up period.Conclusions:The foldless anastomosis is a safe and reliable technique that has exact anastomosis effect in patients with malignant colorectal obstruction after stent implantation.

关 键 词：结直肠肿瘤 肠梗阻 腹腔镜检查 无褶皱吻合 自膨式金属支架 

分 类 号：R735.34[医药卫生—肿瘤]