背景:在腹腔镜右半结肠切除术(LRH)中,可以选择体外吻合术(EA)或体内吻合术(IA)进行消化道重建。然而,LRH联合IA治疗超重右侧结肠癌(RCC)是否可行和有益尚不清楚.本研究旨在探讨IA在LRH中用于超重RCC的可行性和优势。
方法:48例连续超重的RCC患者接受IA的LRH,与48例连续接受EA的LRH患者相匹配。收集和分析临床和手术数据。
结果:术后并发症发生率EA组为20.8%(10/48),IA组为14.6%(7/48)。没有统计学差异。与EA组相比,IA组患者表现出更快的气体(40.27.8h与45.6+7.9小时,P=0.001)和粪便排出量(4.0+1.2dvs.4.5+1.1d,P=0.040),较短的辅助切口(5.3+1.3厘米与7.5+1.2厘米,P=0.000),和较少的镇痛剂使用(3.3+1.3dvs.4.0+1.3d,P=0.012)。手术时间无明显差异,失血,或术后住院。在IA组中,前三分之一的病例表现出更长的手术时间(228.4+29.3分钟),而中期(191.0+35.0分钟,P=0.003)和最后三分之一的患者(182.220.7分钟,P=0.000)。
结论:LRH与IA是可行和安全的超重RCC,肠功能恢复更快,疼痛更少。合并IA的某些LRH病例的积累将有助于外科手术并减少手术时间。
BACKGROUND: Either extracorporeal anastomosis (EA) or intracorporeal anastomosis (IA) could be selected for digestive reconstruction in laparoscopic right hemicolectomy (LRH). However, whether LRH with IA is feasible and beneficial for overweight right-side colon cancer (RCC) is unclear. This study aims to investigate the feasibility and advantage of IA in LRH for overweight RCC.
METHODS: Forty-eight consecutive overweight RCC patients undergoing LRH with IA were matched with 48 consecutive cases undergoing LRH with EA. Both clinical and surgical data were collected and analyzed.
RESULTS: The incidence of postoperative complications was 20.8% (10/48) in the EA group and 14.6% (7/48) in the IA group respectively, with no statistical difference. Compared to the EA group, patients in the IA group revealed faster gas (40.2 + 7.8 h vs. 45.6 + 7.9 h, P = 0.001) and stool discharge (4.0 + 1.2 d vs. 4.5 + 1.1 d, P = 0.040), shorter assisted incision (5.3 + 1.3 cm vs. 7.5 + 1.2 cm, P = 0.000), and less analgesic used (3.3 + 1.3 d vs. 4.0 + 1.3 d, P = 0.012). There were no significant differences in operation time, blood loss, or postoperative hospital stays. In the IA group, the first one third of cases presented longer operation time (228.4 + 29.3 min) compared to the middle (191.0 + 35.0 min, P = 0.003) and the last one third of patients (182.2 + 20.7 min, P = 0.000).
CONCLUSIONS: LRH with IA is feasible and safe for overweight RCC, with faster bowel function recovery and less pain. Accumulation of certain cases of LRH with IA will facilitate surgical procedures and reduce operation time.