腹腔镜右半结肠癌根治术中闭合系膜裂隙对围手术期影响的全国多中心前瞻性研究  

A nationwide multicenter prospective study on the perioperative impact of closure of mesen-teric fissure in laparoscopic right hemicolectomy

作　　者：刘刚[1] 徐炜民 李达 乔雷[3] 袁杰庆 张德巍[5] 刘岩[6] 郭帅 张旭[7] 刘文志[7] 王英飞 陆航 张晓威 陈鑫[10] 徐朝辉 罗兴扬[11] 刘革[12] 张成 周建平[1] Liu Gang;Xu Weimin;Li Da;Qiao Lei;Yuan Jieqing;Zhang Dewei;Liu Yan;Guo Shuai;Zhang Xu;Liu Wenzhi;Wang Yingfei;Lu Hang;Zhang Xiaowei;Chen Xin;Xu Zhaohui;Luo Xingyang;Liu Ge;Zhang Cheng;Zhou Jianping(Department of Gastrointestinal Surgery,The First Affliated Hospital of China Medical University,Shenyang 110001,China;Department of General Surgery,General Hospital of Northern Theater Command,Shenyang 110011,China;Department of Colorectal&Hernia Minimally Invasive Surgery,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Oncological Surgery,Chaoyang Central Hospital,Chaoyang 122000,China;Department of General Surgery,The Fourth Affiliated Hospital of China Medical University,Shenyang 110084,China;Department of Gastrointestinal Surgery,The Second Affiliated Hospital of Dalian Medical University,Dalian 116023,China;Department of General Surgery,The Affiliated Zhongshan Hospital of Dalian University,Dalian 116001,China;Department of General Surgery,Liaoyang Central Hospital,Liaoyang 111010,China;Department of Colorectal and Anal Surgery,The First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121004,China;Department of Hernia and Colorectal Surgery,The Second Afiliated Hospital of Dalian Medical University,Dalian 116023,China;Department of General Surgery,Dandong Central Hospital,Dandong 118002,China;Department of General Surgery,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]中国医科大学附属第一医院胃肠外科/疝与腹壁外科,沈阳110001 [2]北部战区总医院普通外科,沈阳110011 [3]中国医科大学附属盛京医院结直肠和疝微创外科,沈阳110004 [4]朝阳市中心医院肿瘤外科,朝阳122000 [5]中国医科大学附属第四医院普通外科,沈阳110084 [6]大连医科大学附属第二医院胃肠外科,大连116023 [7]大连大学附属中山医院普通外科,大连116001 [8]辽阳市中心医院普通外科,辽阳111010 [9]锦州医科大学附属第一医院大肠肛门外科,锦州121004 [10]大连医科大学附属第二医院疝与结直肠外科,大连116023 [11]丹东市中心医院普通外科,丹东118002 [12]大连医科大学附属第一医院普通外科,大连116011

出　　处：《中华消化外科杂志》2024年第6期812-818,共7页Chinese Journal of Digestive Surgery

基　　金：辽宁省应用基础研究计划项目(1655189294903);沈阳市科技计划项目(20-205-4-096)。

摘　　要：目的探讨腹腔镜右半结肠癌根治术中闭合系膜裂隙对围手术期的影响。方法采用前瞻性随机对照研究方法。选取2022年11月至2023年8月中国医科大学附属第一医院等全国11家医学中心收治的320例行腹腔镜右半结肠癌根治术患者的临床资料,按照区组随机化法将患者分为系膜裂隙非闭合组和系膜裂隙闭合组。观察指标:(1)入组患者分组情况。(2)术中情况。(3)术后情况。偏态分布的计量资料以M(Q_(1),Q_(3))表示,组间比较采用Mann-WhitneyU检验。计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验或Fisher确切概率法。等级资料比较采用秩和检验。疼痛视觉模拟量表(VAS)评分比较采用广义估计方程分析。结果(1)入组患者分组情况。筛选出符合研究条件的结肠癌患者320例;男156例,女164例;年龄为68(59,73)岁。320例患者随机分配至系膜裂隙非闭合组164例和系膜裂隙闭合组156例。两组患者年龄、体质量指数、美国麻醉医师协会评分、肿瘤最大径、吻合位置、吻合方式、手术入路方式、淋巴结清扫范围、肿瘤分期比较,差异均无统计学意义(P>0.05);性别比较,差异有统计学意义(P<0.05)。(2)术中情况。两组患者术中出血量、手术时间、中转开腹、术中并发症比较,差异均无统计学意义(P>0.05)。系膜裂隙非闭合组3例患者中转开腹;系膜裂隙闭合组1例患者中转开腹。系膜裂隙闭合组2例患者发生术中并发症均为肠系膜血肿。(3)术后情况。两组患者术后总并发症比较,差异无统计学意义(χ^(2)=0.28,P>0.05);其中肠梗阻、腹胀、腹腔积液、胸腔积液、胃瘫、吻合口出血、吻合口漏、手术部位感染比较,差异均无统计学意义(P>0.05)。两组患者再次手术、术后重置胃管比较,差异均无统计学意义(P>0.05);术后首次肛门排气时间、术后首次进食流质食物时间、术后首次肛门排便时间、术后住院时Objective To investigate the perioperative impact of closure of mesenteric fissure in laparoscopic right hemicolectomy.Methods The prospective randomized controlled trial was conducted.The clinical data of 320 patients who underwent laparoscopic right hemicolectomy in 11 medical centers,including The First Affiliated Hospital of China Medical University et al,from November 2022 to August 2023 were selected.Based on block randomization,patients were allocated into the mesenteric fissure non-closure group and the mesenteric fissure closure group.Observation indicators:(1)grouping of the enrolled patients;(2)intraoperative conditions;(3)postoperative conditions.Measurement data with skewed distribution were represented as M(Q_(1),Q_(3))and com-parison between groups was conducted using the Mann-Whitney U test.Count data were represen-ted as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test or Fisher's exact probability.Comparison of ordinal data was conducted using the rank sum test.Comparison of visual analog scores was analyzed using generalized estimating equations.Results(1)Grouping of the enrolled patients.A total of 320 patients with colon cancer were screened for eligibility,including 156 males and 164 females,aged 68(59,73)years.All the 320 patients were allocated into the mesenteric fissure non-closure group with 164 cases and the mesenteric fissure closure group with 156 cases.There was no significant difference in the age,body mass index,American Society of Anesthesiologist score,maximum tumor diameter,anastomosis location,anastomosis method,surgical approach,range of lymph node dissection,tumor staging between the two groups(P>0.05)and there was a significant difference in the sex between them(P<0.05).(2)Intraoperative conditions.There was no significant difference between the mesenteric fissure closure group and the mesenteric fissure non-closure group in the volume of intraoperative blood loss,operation time,conversion to laparotomy,intraoperative com

关 键 词：结直肠肿瘤 右半结肠 右半结肠癌根治术 系膜裂隙闭合 肠梗阻 腹腔镜检查 

分 类 号：R735.35[医药卫生—肿瘤]