| 郭杰东,朱灿,胡启航,等.全腹腔镜顺蠕动侧侧吻合在左半结肠癌根治术中的临床疗效观察[J].安徽医药,2024,28(11):2179-2183. |
| 全腹腔镜顺蠕动侧侧吻合在左半结肠癌根治术中的临床疗效观察 |
| Clinical efficacy of total laparoscopic overlap anastomosis in radical surgery for left sided colon cancer |
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| DOI：10.3969/j.issn.1009-6469.2024.11.013 |
| 中文关键词: 结肠肿瘤 内窥镜检查，胃肠道 左半结肠 全腹腔镜顺蠕动侧侧吻合 临床疗效 |
| 英文关键词: Colon tumor Endoscopy,gastrointestinal Left sided colon Total laparoscopic overlap anastomosis Clinical efficacy |
| 基金项目:国家自然科学基金资助项目( 82073133)；江苏省“六大人才高峰”高层次人才项目(WSW-050)；徐州医学领军人才培养项目( XWRCHT20210034) |
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| 中文摘要: |
| 目的探讨全腹腔镜顺蠕动侧侧吻合( Overlap)在左半结肠癌( LCC)根治术中的临床疗效。方法选取 2021年 6月至 2023年 6月徐州医科大学附属医院收治的 LCC病人 87例。根据消化道重建技术分为观察组 42例，采用全腹腔镜 Overlap吻合术；对照组 45例，采用传统体外吻合术。比较两组手术时长、辅助切口长度、术中出血量、术后首次肛门排气时间以及术后住院时长。比较两组肠道屏障功能指标(谷氨酰胺、二胺氧化酶、 D-乳酸)、炎症指标(超敏 C反应蛋白、降钙素原)、数字等级量表(NRS)疼痛程度评分、并发症发生率等。结果两组手术时间、出血量以及术后住院时长比较，差异无统计学意义( P>0.05)。观察组辅助切口长度短于对照组［( 5.1±0.8)cm比( 6.9±1.5)cm，P<0.001］、术后首次肛门排气时间早于对照组［( 1.3±0.5)d比(2.3±0.6)d，P<0.001］。术前，两组血清谷氨酰胺、二胺氧化酶、 D-乳酸、超敏 C反应蛋白及降钙素原水平比较，差异无统计学意义(P>0.05)。术后第 7天，两组二胺氧化酶、 D-乳酸、超敏 C反应蛋白及降钙素原水平相比于术前均升高，观察组病二胺氧化酶［( 2.4±0.3)U/mL比( 3.1±0.4)U/mL，P<0.001］、 D-乳酸［( 3.4±0.5)mg/L比( 4.1±0.7)mg/L，P<0.001］、超敏 C反应蛋白［( 13.25± 2.64)mg/L比( 18.28±3.78)mg/L，P<0.001］及降钙素原水平［( 0.25±0.12)μg/L比( 0.39±0.15)μg/L，P<0.001］普遍低于对照组；清谷氨酰胺水平低于术前，观察组高于对照组［( 547.8±40.6)μmol/L比( 518.4±35.3)μmol/L，P<0.001］。术后疼痛程度评分显血示，观察组在术后第 1、3、7天的疼痛程度显著低于对照组( P<0.05)。此外，观察组在术后首月的并发症发生率也低于对照组(P<0.05)。结论全腹腔镜 Overlap吻合术在降低手术创伤、加快胃肠功能恢复及降低并发症风险方面相较于传统手术具有 |
| 英文摘要: |
| Objective To investigate the clinical efficacy of total laparoscopic overlap anastomosis in radical resection of left sided colon cancer (LCC).Methods A retrospective analysis was conducted on 87 LCC patients treated at the Affiliated Hospital of XuzhouMedical University from June 2021 to June 2023. Patients were divided into two groups based on the digestive tract reconstruction technique used: one group of 42 had total laparoscopic overlap anastomosis and the other group of 45 had conventional extracorporeal anastomosis. Surgical-related data between the two groups were compared, including operation duration, length of auxiliary incision, intraoperative blood loss, time to first anal gas passage after surgery, and length of postoperative hospital stay. Additionally, the performance ofthe two groups in terms of intestinal barrier function indicators (such as glutamine, diamine oxidase, D-lactic acid), inflammatory markers (such as high-sensitivity C-reactive protein, procalcitonin), NRS pain score, and complication rates were compared.Results The study compared total laparoscopic Overlap anastomosis with conventional extracorporeal anastomosis and found no significant differ ence between the two procedures in terms of operative time, bleeding and length of postoperative hospital stay (P>0.05). The length of the surgically assisted incision was shorter in the observation group than that in the control group [(5.1 ± 0.8) cm vs. (6.9 ± 1.5) cm, P< 0.001], and the time to first postoperative anal voiding was earlier than that in the control group [(1.3 ± 0.5) d vs. (2.3 ± 0.6) d, P< 0.001]. Preoperatively, there were no significant differences in glutamine, diamine oxidase, D-lactic acid, high-sensitivity C-reactive protein, and procalcitonin levels between the two groups (P>0.05). On postoperative day 7, although the levels of diamine oxidase, D-lactic acid, high-sensitivity C-reactive protein and procalcitonin were elevated in both groups compared with the preoperative period,the levels of diamine oxidase [(2.4±0.3) U/mL vs. (3.1±0.4) U/mL, P<0.001], D-lactic acid [(3.4±0.5) mg/L vs. (4.1±0.7) mg/L, P< 0.001], high-sensitivity C-reactive protein [(13.25±2.64) mg/L vs. (18.28±3.78) mg/L, P<0.001] and procalcitonin levels [(0.25±0.12) μg/L vs. (0.39±0.15) μg/L, P<0.001] in the observation group were generally lower than those of the control group; glutamine levelswere lower than those of the preoperative period, but higher in the observation group than in the control group [(547.8±40.6) μmol/L vs. (518.4±35.3) μmol/L, P<0.001]. Furthermore, in pain score assessments on postoperative days 1, 3, and 7, the observation group consistently scored significantly lower than the conventional extracorporeal anastomosis group (P<0.05). Within the first month after surgery,the observation group also had a lower complication rate compared to the conventional extracorporeal anastomosis group (P<0.05).Con? clusions Total laparoscopic overlap anastomosis demonstrates advantages over conventional extracorporeal anastomosis in reducingsurgical trauma, accelerating gastrointestinal function recovery, and lowering the risk of complications. This approach plays a positiverole in shortening hospitalization time and expediting the postoperative recovery process for LCC patients. |
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