两种机械吻合方式在腹腔镜辅助右半结肠癌术中的回顾性对照研究_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

程康文 ,  王贵和 , 束宽山 , 郑明 , 刘红霞 , 马冬花

铜陵市人民医院胃肠外科（安徽铜陵 244000）;

Corresponding author：

王贵和, Email: yiyuanckw@163.com

Keywords：

结肠肿瘤; 腹腔镜; 结肠切除术; 吻合术

DOI：

10.7507/1007-9424.201902031

Video：

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目的比较体外机械性侧侧吻合与端侧吻合在腹腔镜辅助右半结肠癌根治术中的应用效果。方法回顾性分析笔者所在医院 2015 年 6 月至 2018 年 6 月期间采用机械吻合进行消化道重建的 89 例腹腔镜辅助右半结肠癌根治术患者的临床资料，其中机械性侧侧吻合 32 例，机械性端侧吻合 57 例；比较 2 组患者的一般资料、手术时间、术中出血量、术后首次肛门排气时间、耐受流质饮食时间和术后住院时间；并比较术后并发症发生情况。结果 2 组患者的一般资料、术中出血量、耐受流质饮食时间和术后住院时间的差异均无统计学意义（P>0.05）；端侧吻合组手术时间短于侧侧吻合组［160.0（150.0，177.5） min 比 170.0（156.3，203.8）min］，差异有统计学意义（P=0.049）；端侧吻合组首次肛门排气时间短于侧侧吻合组［（2.5±0.9）d 比（3.0±1.0）d］，差异有统计学意义（P=0.021）；2 组患者术后各并发症发生率差异无统计学意义（P>0.05）。结论腹腔镜辅助右半结肠癌根治性切除手术中相比机械性侧侧吻合，机械性端侧吻合的手术时间及术后首次肛门通气时间较短，其并发症无统计学差异，提示机械性端侧吻合可能更具优势。

Citation： 程康文, 王贵和, 束宽山, 郑明, 刘红霞, 马冬花. 两种机械吻合方式在腹腔镜辅助右半结肠癌术中的回顾性对照研究. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(7): 856-860. doi: 10.7507/1007-9424.201902031 Copy

1.	Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol, 2009, 10(1): 44-52.
2.	Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet, 2005, 365(9472): 1718-1726.
3.	Simillis C, Purkayastha S, Yamamoto T, et al. A meta-analysis comparing conventional end-to-end anastomosis vs. other anastomotic configurations after resection in Crohn’s disease. Dis Colon Rectum, 2007, 50(10): 1674-1687.
4.	Cirocchi R, Trastulli S, Farinella E, et al. Intracorporeal versus extracorporeal anastomosis during laparoscopic right hemicolectomy—systematic review and meta-analysis. Surg Oncol, 2013, 22(1): 1-13.
5.	Puleo S, Sofia M, Trovato MA, et al. Ileocolonic anastomosis: preferred techniques in 999 patients. A multicentric study. Surg Today, 2013, 43(10): 1145-1149.
6.	Liu Z, Wang G, Yang M, et al. Ileocolonic anastomosis after right hemicolectomy for colon cancer: functional end-to-end or end-to-side? World J Surg Oncol, 2014, 12: 306.
7.	Lee KH, Lee SM, Oh HK, et al. Comparison of anastomotic configuration after laparoscopic right hemicolectomy under enhanced recovery program: side-to-side versus end-to-side anastomosis. Surg Endosc, 2016, 30(5): 1952-1957.
8.	Offodile AC 2nd, Feingold DL, Nasar A, et al. High incidence of technical errors involving the EEA circular stapler: a single institution experience. J Am Coll Surg, 2010, 210(3): 331-335.
9.	李新峰, 侯臣芳. 腹腔镜结肠癌根治术与开腹结肠癌根治术的近、远期疗效对比. 现代肿瘤医学, 2017, 25(4): 584-587.
10.	李继勇. 腹腔镜和开腹右半结肠癌根治术临床对比分析. 临床外科杂志, 2017, 25(9): 685-687.
11.	Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation-technical notes and outcome. Colorectal Dis, 2009, 11(4): 354-364.
12.	Oh HK, Ihn MH, Son IT, et al. Factors associated with failure of enhanced recovery programs after laparoscopic colon cancer surgery: a single-center retrospective study. Surg Endosc, 2016, 30(3): 1086-1093.
13.	Smith TK, Robertson WJ. Synchronous movements of the longitudinal and circular muscle during peristalsis in the isolated guinea-pig distal colon. J Physiol, 1998, 506(Pt 2): 563-577.
14.	Moon SB, Park KJ, Moon JS, et al. Migrating motor complex changes after side-to-side ileal bypass in mouse ileum ex vivo: mechanism underlying the blind loop syndrome? J Korean Surg Soc, 2011, 80(4): 251-259.
15.	Muñoz-Juárez M, Yamamoto T, Wolff BG, et al. Wide-lumen stapled anastomosis vs. conventional end-to-end anastomosis in the treatment of Crohn’s disease. Dis Colon Rectum, 2001, 44(1): 20-25.
16.	俞旻皓, 祁洋, 秦绍岚, 等. 腹腔镜与开腹右半结肠癌全结肠系膜切除术的回顾性临床对照研究. 外科理论与实践, 2018, 23(2): 145-149.
17.	李建. 腹腔镜右半结肠癌 CME 手术临床效果分析. 中华普外科手术学杂志 (电子版), 2017, 11(2): 111-113.
18.	李方琨, 陈修涛, 谢慧臣. 不同吻合方式在腹腔镜辅助右半结肠切除术中的疗效比较. 腹腔镜外科杂志, 2018, 23(10): 782-785.
19.	Resegotti A, Astegiano M, Farina EC, et al. Side-to-side stapled anastomosis strongly reduces anastomotic leakage rates in Crohn’s disease surgery. Dis Colon Rectum, 2005, 48(3): 464-468.

1. Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol, 2009, 10(1): 44-52.
2. Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet, 2005, 365(9472): 1718-1726.
3. Simillis C, Purkayastha S, Yamamoto T, et al. A meta-analysis comparing conventional end-to-end anastomosis vs. other anastomotic configurations after resection in Crohn’s disease. Dis Colon Rectum, 2007, 50(10): 1674-1687.
4. Cirocchi R, Trastulli S, Farinella E, et al. Intracorporeal versus extracorporeal anastomosis during laparoscopic right hemicolectomy—systematic review and meta-analysis. Surg Oncol, 2013, 22(1): 1-13.
5. Puleo S, Sofia M, Trovato MA, et al. Ileocolonic anastomosis: preferred techniques in 999 patients. A multicentric study. Surg Today, 2013, 43(10): 1145-1149.
6. Liu Z, Wang G, Yang M, et al. Ileocolonic anastomosis after right hemicolectomy for colon cancer: functional end-to-end or end-to-side? World J Surg Oncol, 2014, 12: 306.
7. Lee KH, Lee SM, Oh HK, et al. Comparison of anastomotic configuration after laparoscopic right hemicolectomy under enhanced recovery program: side-to-side versus end-to-side anastomosis. Surg Endosc, 2016, 30(5): 1952-1957.
8. Offodile AC 2nd, Feingold DL, Nasar A, et al. High incidence of technical errors involving the EEA circular stapler: a single institution experience. J Am Coll Surg, 2010, 210(3): 331-335.
9. 李新峰, 侯臣芳. 腹腔镜结肠癌根治术与开腹结肠癌根治术的近、远期疗效对比. 现代肿瘤医学, 2017, 25(4): 584-587.
10. 李继勇. 腹腔镜和开腹右半结肠癌根治术临床对比分析. 临床外科杂志, 2017, 25(9): 685-687.
11. Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation-technical notes and outcome. Colorectal Dis, 2009, 11(4): 354-364.
12. Oh HK, Ihn MH, Son IT, et al. Factors associated with failure of enhanced recovery programs after laparoscopic colon cancer surgery: a single-center retrospective study. Surg Endosc, 2016, 30(3): 1086-1093.
13. Smith TK, Robertson WJ. Synchronous movements of the longitudinal and circular muscle during peristalsis in the isolated guinea-pig distal colon. J Physiol, 1998, 506(Pt 2): 563-577.
14. Moon SB, Park KJ, Moon JS, et al. Migrating motor complex changes after side-to-side ileal bypass in mouse ileum ex vivo: mechanism underlying the blind loop syndrome? J Korean Surg Soc, 2011, 80(4): 251-259.
15. Muñoz-Juárez M, Yamamoto T, Wolff BG, et al. Wide-lumen stapled anastomosis vs. conventional end-to-end anastomosis in the treatment of Crohn’s disease. Dis Colon Rectum, 2001, 44(1): 20-25.
16. 俞旻皓, 祁洋, 秦绍岚, 等. 腹腔镜与开腹右半结肠癌全结肠系膜切除术的回顾性临床对照研究. 外科理论与实践, 2018, 23(2): 145-149.
17. 李建. 腹腔镜右半结肠癌 CME 手术临床效果分析. 中华普外科手术学杂志 (电子版), 2017, 11(2): 111-113.
18. 李方琨, 陈修涛, 谢慧臣. 不同吻合方式在腹腔镜辅助右半结肠切除术中的疗效比较. 腹腔镜外科杂志, 2018, 23(10): 782-785.
19. Resegotti A, Astegiano M, Farina EC, et al. Side-to-side stapled anastomosis strongly reduces anastomotic leakage rates in Crohn’s disease surgery. Dis Colon Rectum, 2005, 48(3): 464-468.

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两种机械吻合方式在腹腔镜辅助右半结肠癌术中的回顾性对照研究

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