十字吻合在腹腔镜结肠癌根治术中的应用价值

Application value of cruciform anastomosis in the laparoscopic radical resection of colon cancer

    摘要
  • 摘要: 目的:评价十字吻合在腹腔镜结肠癌根治术中的安全性和可行性。
    方法:采用回顾性描述性研究方法。收集2011年12月至2013年10月山西省肿瘤医院收治的9例结肠癌患者的临床病理资料。在腹腔镜下完成结肠游离和淋巴结清扫后，运用直线切割闭合器切断肿瘤两端结肠，将两结肠断端靠拢，在两切端各切开一个小口后将直线切割闭合器分别插入其中，然后在系膜对侧进行肠壁切割闭合，再运用直线切割闭合器将鸟嘴样共同开口闭合，完成腹腔镜下的消化道重建。观察指标：(1)手术学指标：手术时间、十字吻合时间、术中出血量、中转开腹情况。(2)肿瘤学指标：淋巴结清扫数目、切缘距肿瘤距离、R0切除情况。(3)手术并发症：吻合口闭合不全、吻合口漏、狭窄、肠扭转、伤口液化感染。(4)术后康复时间：术后首次下床活动时间、肛门排气时间、进食流质食物时间、术后住院时间。(5)随访情况。采用门诊方式随访，卡氏评分评估身体状况、纤维结肠镜检查有无肿瘤吻合口复发、肠腔狭窄。随访时间截至2014年4月。正态分布的计量资料以±s表达。
    结果:(1)手术学指标：9例患者均成功施行全腹腔镜结肠癌切除+淋巴结D3清扫和十字吻合术。手术时间为(140±50)min，十字吻合时间为(43±26)min，术中出血量为 (62±56)mL。全组无一例患者中转开腹。(2)肿瘤学指标：淋巴结清扫数目为(17±6)枚/例。切缘距肿瘤距离均≥8 cm，病理学检查结果均未见癌细胞残留。(3)手术并发症：9例患者未出现术后吻合口出血、瘘和狭窄等相关并发症。(4)术后康复时间：9例患者术后首次下床活动时间为(1.8±0.9)d，肛门排气时间为(2.4±1.2)d，进食流质食物时间为(3.6±1.7)d，术后住院时间为(9.6±2.5)d。所有患者在术后12 d出院，无因手术原因术后30 d内再入院。(5)随访情况：所有患者术后6个月门诊随访，卡氏评分均≥90分。纤维结肠镜检查无吻合口复发、肠腔狭窄。
    结论:十字吻合技术在腹腔镜结肠癌根治术中安全可行。

     

    Abstract: Objective:To evaluate the safety and feasibility of cruciform anastomosis in the laparoscopic radical resection of colon cancer.
    Methods:The retrospective descriptive study was adopted. The clinicopathologic data of 9 patients with colon cancer who were admitted to the Shanxi Provincial Caner Hospital between December 2011 to October 2013 were collected. After the laparoscopic free colon and dissection of lymph nodes, the proximal and distal ends of the colon tumor were cut off using an ENDO-GIA, cutting one small incision on the both side of stump, and ENDO-GIA was put into the incision to staple the mesentery of colonic wall, finally, the beaklike common incision was closed by ENDO-GIA and digestive tract construction was conducted. Observation indices: (1) operative indices: operation time, time of cruciform colon anastomosis, volume of intraoperative blood loss, conversion to open surgery. (2) Tumor indices: number of lymph nodes dissected, distance to resection margin, R0 resection. (3) Surgical complications: anastomotic stoma incompetence, anastomotic leakage, anastomotic stenosis, twisting of bowel, wound liquefaction infection. (4) Postoperative recovery time: time for initial outofbed activity, time to anal exsufflation, time for fluid diet intake, duration of postoperative hospital stay. (5) Followup situations: followup using outpatient examination was conducted up to April 2014. Karnofsky performance status (KPS) score was used to evaluate the health conditions and tumor recurrence of anastomotic stoma and colonic cavity stenosis were detected by fibercoloscope. Measurement data with normal distribution were presented as ±s.
    Results: (1) Operative indices: 9 patients received successful total laparoscopic resection of colon cancer+D3 lymph node dissection+cruciform anastomosis, without conversion to open surgery. Operation time, time of cruciform colon anastomosis and volume of intraoperative blood loss were respectively (140±50)minutes, (43±26)minutes and (62±56)mL. (2) Tumor indices: the number of lymph nodes dissected was 17±6 percase. The distance to resection margin was more than 8 cm, and pathological findings showed no residual cancer. (3) Surgical complications: 9 patients had no postoperative complications. (4) Postoperative recovery time: time for initial outofbed activity, time to anal exsufflation, time for fluid diet intake and duration of hospital stay were respectively (1.8±0.9)days, (2.4±1.2)days, (3.6±1.7)days and (9.6±2.5)days. All the patients were discharged from hospital at postoperative day 12, without the occurrence of readmission within postoperative day 30. (5) Followup situations: all the patients were followed up by outpatient examination at postoperative month 6, with KPS score≥90 and without the occurrence of tumor recurrence of anastomotic stoma and colonic cavity stenosis.
    Conclusion:Cruciform anastomosis in the laparoscopic radical resection of colon cancer is safe and feasible.

     

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