优化系膜裂孔缝合技术在腹腔镜辅助右半结肠切除术中的应用价值

Application value of optimized mesenteric defect closure technique in laparoscopic‑assisted right hemicolectomy

  • 摘要:
    目的 探讨优化系膜裂孔缝合技术在腹腔镜辅助右半结肠切除术中的应用价值。
    方法 采用回顾性描述性研究方法。收集2023年5月至2024年6月长治医学院附属长治市人民医院收治的26例行腹腔镜辅助右半结肠切除术患者的临床病理资料;男11例,女15例;年龄为(65.7±1.8)岁。患者均采用体外‑腹腔镜联合缝合关闭系膜裂孔的优化系膜裂孔缝合技术。观察指标:(1)手术及术中情况。(2)术后情况。(3)随访情况。正态分布的计量资料以x±s表示,偏态分布的计量资料以MQ1,Q3)或M(范围)表示。计数资料以绝对数表示。
    结果 (1)手术及术中情况。26例患者均顺利完成腹腔镜辅助右半结肠切除+优化系膜裂孔缝合术。优化系膜裂孔缝合时间为9.8(8.8,12.8)min,消化道重建时间为10.0(8.7,13.0)min,手术时间为(164±4)min,术中出血量为50(50,100)mL。26例患者中,1例术中发生肠系膜血肿,未行特殊处理,患者痊愈出院。(2)术后情况。26例患者术后第1天视觉模拟评分为5(4,5)分,术后第3天视觉模拟评分为3(2,3)分,术后首次肛门排气时间为3(3,4)d,术后首次排便时间为3(3,4)d,术后首次进食流质食物时间为2(2,3)d,术后引流管留置时间为4(3,5)d,术后住院时间为9(8,12)d。26例患者淋巴结清扫数目为25(18,27)枚,阳性淋巴结数目为1(0,2)枚;肿瘤TNM分期Ⅰ期、Ⅱ期、Ⅲ期分别为5、6、15例。(3)随访情况。26例患者均获得术后随访,随访时间为15(6~20)个月。26例患者中,1例术后25 d发生不全性肠梗阻,经影像学检查诊断为粘连性肠梗阻,为Clavien‑Dindo Ⅱ级,经保守治疗痊愈出院。26例患者均无出血、切口感染、吻合口瘘、腹内疝、胃排空障碍,均无肿瘤复发、转移及死亡情况。
    结论 体外‑腹腔镜联合缝合关闭系膜裂孔的优化系膜裂孔缝合技术可应用于腹腔镜辅助右半结肠切除术。

     

    Abstract:
    Objective To investigate the application value of optimized mesenteric defect closure technique in laparoscopic‑assisted right hemicolectomy.
    Methods The retrospective and descriptive study was conducted. The clinicopathological data of 26 patients who underwent laparo-scopic-assisted right hemicolectomy at Changzhi People′s Hospital Affiliated to Changzhi Medical College from May 2023 to June 2024 were collected. There were 11 males and 15 females, aged (65.7±1.8)years. All patients received optimized mesenteric defect closure using a combined extra-corporeal‑laparoscopic suturing technique. Observation indicators: (1) surgical and intraoperative conditions; (2) postoperative conditions; (3) follow‑up. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(Q1,Q3) or M(range). Count data were described as absolute numbers.
    Results (1) Surgical and intraoperative conditions. All 26 patients underwent laparoscopic‑assisted right hemicolectomy with optimized mesenteric defect closure. The time of optimized mesenteric defect closure was 9.8(8.8,12.8)minutes, time of digestive tract reconstruction was 10.0(8.7,13.0)minutes, operation time was (164±4)minutes, volume of intraoperative blood loss was 50(50,100)mL. One of the 26 patients had intraoperative mesenteric hematoma, which required no specific intervention. The patient recovered uneventfully and was discharged from hospital. (2) Postoperative conditions. The visual analog scale pain score of 26 patients on postoperative day 1 and day 3 were 5(4,5) and 3(2,3), respectively. Time to postoperative first anal flatus and bowel movement were both 3(3, 4)days. Time to postoperative first intake of liquid diet was 2(2,3)days, duration of postoperative abdominal drainage was 4(3,5)days, and duration of postoperative hospital stay was 9(8,12)days. The number of lymph node dissected in 26 patients was 25(18,27) and the number of positive lymph node was 1(0,2). Cases in stage Ⅰ, stage Ⅱ and stage Ⅲ of tumor TNM staging were 5, 6, 15. (3) Follow‑up. All 26 patients were followed up for 15(range, 6‒20)months. Of the 26 patients, one case had incom-plete intestinal obstruction on postoperative day 25, which was diagnosed as adhesive intestinal obstruction based on imaging examination and classified as Clavien‑Dindo grade Ⅱ. The patient recovered and was discharged after conservative treatment. None of the 26 patients had bleeding, infection of incision, anastomotic leakage, internal hernia, or delayed gastric emptying. There was no tumor recurrence, metastasis or death.
    Conclusion The optimized mesenteric defect closure tech-nique in combined extracorporeal‑laparoscopic suturing procedure can be used in laparoscopic-assisted right hemicolectomy.

     

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