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中华结直肠疾病电子杂志 ›› 2019, Vol. 08 ›› Issue (06) : 596 -601. doi: 10.3877/cma.j.issn.2095-3224.2019.06.009

所属专题: 文献

论著

应用重叠式三角吻合技术的3D完全腹腔镜右半结肠切除术的近期疗效分析
包满都拉1, 苏昊1, 王鹏1, 关旭1, 梁建伟1, 刘正1, 刘骞1, 周志祥1, 王锡山1, 周海涛1,()   
  1. 1. 100021 北京,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科
  • 收稿日期:2019-06-14 出版日期:2019-12-25
  • 通信作者: 周海涛
  • 基金资助:
    中国癌症基金会北京希望马拉松基金(No.LC2016B10); 中国医学科学院医学与健康科技创新工程(协同创新团队项目)(No.2017-I2M-4-002)

The short-term results analysis of overlapped delta-shaped anastomosis in 3D totally laparoscopic right hemicolectomy

Mandula Bao1, Hao Su1, Peng Wang1, Xu Guan1, Jianwei Liang1, Zheng Liu1, Qian Liu1, Zhixiang Zhou1, Xishan Wang1, Haitao Zhou1,()   

  1. 1. Department of Colorectal Surgery, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
  • Received:2019-06-14 Published:2019-12-25
  • Corresponding author: Haitao Zhou
  • About author:
    Corresponding author: Zhou Haitao, Email:
引用本文:

包满都拉, 苏昊, 王鹏, 关旭, 梁建伟, 刘正, 刘骞, 周志祥, 王锡山, 周海涛. 应用重叠式三角吻合技术的3D完全腹腔镜右半结肠切除术的近期疗效分析[J/OL]. 中华结直肠疾病电子杂志, 2019, 08(06): 596-601.

Mandula Bao, Hao Su, Peng Wang, Xu Guan, Jianwei Liang, Zheng Liu, Qian Liu, Zhixiang Zhou, Xishan Wang, Haitao Zhou. The short-term results analysis of overlapped delta-shaped anastomosis in 3D totally laparoscopic right hemicolectomy[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2019, 08(06): 596-601.

目的

比较应用重叠式三角吻合技术的3D与2D完全腹腔镜右半结肠切除术的近期疗效资料,探讨重叠式三角吻合技术在3D完全腹腔镜右半结肠切除术中的可行性和安全性。

方法

回顾性分析中国医学科学院北京协和医学院肿瘤医院2017年5月至2018年10月收治的67例右半结肠恶性肿瘤患者的资料,其中行2D完全腹腔镜右半切除术的患者35例,设为2D组;行3D完全腹腔镜右半切除术的患者32例,设为3D组。对比其手术及术后恢复情况、病理情况以及围手术期并发症等。

结果

两组之间,3D组手术时间、消化道重建时间明显小于2D组(均P<0.05),但术中出血量、手术切口长度差异无统计学意义(P>0.05)。两组患者术后行走时间、排气时间、排便时间、术后住院时间差异无统计学意义(均P>0.05)。两组在肿瘤大小、远近切缘距离、淋巴结清扫数目、肿瘤TNM分期等方面,差异无统计学意义(P>0.05)。两组术后并发症发生率分别为6.2%和5.7%,差异亦无统计学意义(P=0.928)。

结论

重叠式三角吻合技术在3D完全腹腔镜右半结肠切除术切实可行,安全可靠,具有满意的近期疗效。与2D腹腔镜手术相比,在3D腹腔镜下可明显缩短手术时间和消化道重建时间。

Objective

This study aims to explore the safety, feasibility and short-term results of overlapped delta-shaped anastomosis in 3D totally laparoscopic right hemicolectomy.

Methods

From May 2017 to October 2018, a total of 32 and 35 patients who underwent overlapped delta-shaped anastomosis in 3D and 2D total laparoscopic right hemicolectomy were respectively selected. Data regarding surgical outcomes, postoperative recovery, pathological outcomes and complications were collected and compared.

Results

Between the two groups, the operative time and anastomosis time of the 3D group were significantly less than those of the 2D group (all P<0.05), but there was no significant difference in intraoperative blood loss and length of incision (P>0.05). The time to ground activities, first flatus time, first defecation time and postoperative hospitalization did not differ between the two groups (all P>0.05). There was no significant difference between the two groups in tumor size, distance of proximal and distal incisional margins, number of lymph node dissection, TNM stage of the tumor, etc. (P>0.05). The incidence of postoperative complications in the two groups was 6.2% and 5.7%, respectively, with no significant difference (P=0.928).

Conclusions

3D totally laparoscopic right hemicolectomy with overlapped delta-shaped anastomosis is a safe and feasible procedure with a satisfactory short-term effect. Compared with 2D laparoscopic surgery, 3D laparoscopy can shorten the operation time and anastomosis time significantly.

表1 患者的一般资料[±s,例(%)]
图1 腹腔镜戳卡位置
图2 完全腹腔镜右半结肠切除术中重叠式三角吻合技术步骤。2A:拉拢两侧肠管呈重叠摆放;2B:将距离近侧断端约8 cm处肠管与远侧断端缝合固定;2C:分别于近侧断端对系膜缘闭合处及相对应位置的远端结肠对系膜侧做1 cm切口;2D:将张开的直线切割闭合器分别置入两侧肠管系膜对侧的小孔中;2E:用直线切割闭合器闭合两侧肠管共同开口;2F:完成完全腹腔镜下重叠式三角吻合
表2 患者的手术情况及术后恢复情况(±s
表3 患者的病理情况(±s
表4 患者的术后恢复及术后并发症情况
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