平行重叠吻合法在3D腹腔镜下结肠癌根治术中应用的效果及安全性  

Effect and safety of parallel and cross-to-overlap anastomosis in 3Dlaparoscopic radical colon cancer

作　　者：李晓 白军伟 李俊蒙 张超 吴超飞 陈庭豪 李腾龙 叶贺鸣 LI Xiao;BAI Junwei;LI Junmeng;ZHANG Chao;WU Chaofei;CHEN Tinghao;LI Tenglong;YE Heming(Department of Gastrointestinal Surgery,Zhengzhou University People’s Hospital,Henan Provincial People’s Hospital,Zhengzhou,Henan 450003,China)

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

出　　处：《中华实用诊断与治疗杂志》2024年第12期1231-1236,共6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：目的比较3D腹腔镜下结肠癌根治术中消化道重建采用平行重叠吻合法(PCOA)与端侧吻合法治疗结肠癌的效果及安全性,探讨PCOA在结肠癌手术治疗中的应用价值。方法2017年10月—2022年10月河南省人民医院诊治结肠癌患者201例,均行3D腹腔镜下结肠癌根治术,术中消化道重建采用PCOA者153例为PCOA组,采用端侧吻合法者48例为端侧吻合组。记录2组手术时间、术中吻合时间、术中出血量、淋巴结清扫数目、术后首次排气时间、术后首次进流食时间、术后首次下床时间、术后住院时间及术后并发症(吻合口漏、肠梗阻、切口感染、肺部感染等)发生情况。术后随访截至2024年3月,记录患者生存情况及肿瘤复发转移情况,计算总生存率、无病生存率。结果PCOA组术中吻合时间[(23.2±4.4)min]、术后首次排气时间[(2.1±0.9)d]、术后住院时间[(5.1±1.2)d]均短于端侧吻合组[(31.8±6.1)min、(2.7±1.1)d、(6.4±1.1)d](t=8.470,P<0.001;t=4.335,P<0.001;t=9.621,P<0.001),手术时间[(143.0±47.0)min]、术中出血量[(45.1±15.4)mL]、淋巴结清扫数目[(24.0±9.0)个]、术后首次进流食时间[(4.3±1.6)d]、术后首次下床时间[1.6(1.2,1.9)d]与端侧吻合组[(149.3±45.7)min、(46.3±15.6)mL、(23.7±8.7)个、(4.5±1.4)d、1.6(1.3,1.9)d]比较差异均无统计学意义(t=-0.283~1.119,Z=-0.530,P均>0.05)。PCOA组术后发生并发症6例,其中吻合口漏1例,肠梗阻2例,切口感染2例,肺部感染1例;端侧吻合组术后发生并发症7例,其中肠梗阻5例,切口感染2例;PCOA组术后并发症发生率(3.9%)低于端侧吻合组(14.6%)(χ^(2)=5.216,P=0.022)。PCOA组128例完成随访,死亡2例,肿瘤远处转移6例,余120例一般情况良好。端侧吻合组43例完成随访,死亡1例,肿瘤远处转移3例,余39例一般情况良好。PCOA组总生存率(98.4%)、无病生存率(93.8%)与端侧吻合组(97.7%、90.7%)比较差异均无统计学意义(χ^(2)=0.294,P=0.588;χ^(2)=1.419,P=0.232)�Objective To compare the effect and safety of parallel and cross-to-overlap anastomosis(PCOA)and end-to-side anastomosis during gastrointestinal tract reconstruction in 3Dlaparoscopic radical resection of colon cancer,and to explore the value of PCOA in the surgical treatment of colon cancer.Methods From October 2017to October 2022,201patients with colon cancer underwent 3Dlaparoscopic radical resection of colon cancer in Henan Provincial People’s Hospital,among whom 153patients were performed PCOA(PCOA group)and 48patients were subjected to end-to-side anastomosis(end-to-side anastomosis group)in gastrointestinal tract reconstruction.The surgery time,anastomosis time and blood loss during surgery,number of lymph node dissection,time to first flatus,oral fluid-food intake and off-bed activity after surgery,length of postsurgical hospital stay,and postsurgical complications(anastomotic leakage,intestinal obstruction,incision infection,pulmonary infection,etc.)were recorded in two groups.The follow-up was conducted till March 2024to record the survival and tumor recurrence and metastasis,and the overall survival and disease-free survival rates were calculated.Results The intrasurgical anastomosis time,the time to first postsurgical flatus and the length of postsurgical hospital stay were shorter in the PCOA group[(23.2±4.4)min,(2.1±0.9)d,(5.1±1.2)d]than those in the end-to-side anastomosis group[(31.8±6.1)min,(2.7±1.1)d,(6.4±1.1)d](t=8.470,P<0.001;t=4.335,P<0.001;t=9.621,P<0.001),and there were no significant differences in the surgery time,intrasurgical blood loss,number of lymph node dissection,time to first oral fluid-food intake and time to first off-bed activity after surgery between the PCOA group[(143.0±47.0)min,(45.1±15.4)mL,24.0±9.0,(4.3±1.6)d,1.6(1.2,1.9)d]and the end-to-side anastomosis group[(149.3±45.7)min,(46.3±15.6)mL,23.7±8.7,(4.5±1.4)d,1.6(1.3,1.9)d](t=-0.283to 1.119,Z=-0.530;all P values>0.05).The postsurgical complications occurred in 6cases in the PCOA group,including anastomotic

关 键 词：结肠癌 3D腹腔镜 结肠癌根治术 消化道重建 平行重叠吻合法 端侧吻合法 

分 类 号：R735.35[医药卫生—肿瘤]