腹腔镜右半结肠切除术中腹腔内吻合的临床疗效OA
Clinical efficacy of intra-abdominal anastomosis in laparoscopic right hemicolectomy
目的·探讨腹腔镜右半结肠切除术中腹腔内吻合的临床疗效.方法·收集2020年1月至2024年2月期间在上海交通大学医学院附属第九人民医院确诊并接受腹腔镜右半结肠切除术的92例右半结肠癌患者的临床资料.根据术中吻合方式的不同,将病例分为腹腔内吻合组和腹腔外吻合组.收集并比较2组患者的围手术期一般资料、术中情况、术后恢复情况及术后30 d内的短期并发症等临床资料.结果·经过倾向评分匹配,最终获得64例匹配良好的患者,腹腔内吻合组和腹腔外吻合组各32例.腹腔内吻合组的术中出血量明显少于腹腔外吻合组(P<0.001),辅助切口长度也较短(P<0.001);腹腔内吻合组患者的首次排气时间和首次排便时间均较短(P=0.012,P=0.003),术后疼痛评分也较低(P<0.001);腹腔内吻合组总体短期并发症发生率为21.88%,手术部位感染发生率为6.25%,显著低于腹腔外吻合组的37.50%和28.13%(P=0.041,P=0.032).术后30 d内,腹腔内吻合组严重并发症(Clavien-Dindo≥Ⅱ级)发生率(12.50%)也显著低于腹腔外吻合组的31.25%(P=0.045).结论·与腹腔镜右半结肠切除术的腹腔外吻合相比,腹腔内吻合在术中出血量、创伤程度、肠道功能恢复速度、术后疼痛感以及短期并发症发生率等方面均具有显著优势.
Objective·To explore the clinical effects of intra-abdominal anastomosis in laparoscopic right hemicolectomy.Methods·Clinical data were collected from 92 patients diagnosed with right-sided colon cancer who underwent laparoscopic right hemicolectomy at Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,from January 2020 and February 2024.The patients were divided into an intra-abdominal anastomosis group and an extra-abdominal anastomosis group according to the intraoperative anastomosis method.Perioperative general data,intraoperative conditions,postoperative recovery,and short-term complications within 30 d after surgery were collected and compared between the two groups.Results·After propensity score matching,64 well-matched patients were obtained,with 32 cases in the intra-abdominal anastomosis group and 32 cases in the extra-abdominal anastomosis group.The intraoperative blood loss in the intra-abdominal anastomosis group was significantly lower than that in the extra-abdominal anastomosis group(P<0.001),and the length of the auxiliary incision was also shorter(P<0.001).Patients in the intra-abdominal anastomosis group had shorter time to first flatus(P=0.012)and time to first defecation(P=0.003),as well as lower postoperative pain scores(P<0.001).The overall incidence of short-term complications and the incidence of surgical site infection in the intra-abdominal anastomosis group were 21.88%and 6.25%,respectively,which were significantly lower than those in the extra-abdominal anastomosis group(37.50%and 28.13%,respectively;P=0.041 and P=0.032).Within 30 d postoperatively,the intra-abdominal anastomosis group had significantly lower severe complication(Clavien-Dindo≥grade Ⅱ)rate compared with the extra-abdominal anastomosis group(12.50%vs 31.25%,P=0.045).Conclusion·Compared with extra-abdominal anastomosis in laparoscopic right hemicolectomy,intra-abdominal anastomosis demonstrates significant advantages in terms of reduced intraoperative blood loss,less surgical trauma,faster recovery of intestinal function,lower postoperative pain,and a lower incidence of short-term complications.
江爽;俞继卫
上海交通大学医学院附属第九人民医院普外科,上海 201999上海交通大学医学院附属第九人民医院普外科,上海 201999
医药卫生
右半结肠癌腹腔镜下右半结肠切除术腹腔内吻合腹腔外吻合
right-sided colon cancerlaparoscopic right hemicolectomyintra-abdominal anastomosisextra-abdominal anastomosis
《上海交通大学学报（医学版）》 2026 (4)
502-508,7
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