中国实用外科杂志

中国实用外科杂志

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腹腔内与腹腔外吻合对腹腔镜右半结肠切除术后近期并发症影响分析

李珂璇，吴    斌，林国乐，邱辉忠，陆君阳，周皎琳，孙曦羽，牛备战，丛    林，徐 徕，肖    毅   

  1. 中国医学科学院北京协和医学院 北京协和医院基本外科结直肠专业组，北京 100730
  • 出版日期:2021-10-01

  • Online:2021-10-01

摘要： 目的    对比分析腹腔镜右半结肠切除术中行腹腔内与腹腔外吻合后近期并发症发生情况。方法    回顾性分析2017-01-01至2021-01-07北京协和医院基本外科结直肠专业组收治的294例行腹腔镜右半结肠切除术病人的临床资料，术中行腹腔内吻合86例（腹腔内吻合组），行腹腔外吻合208例（腹腔外吻合组）。使用Cochran-Mantel-Haenszel 检验排除分层因素的混杂作用后，分析吻合位置对腹腔感染、吻合口漏、手术切口感染等术后并发症的影响。结果    腹腔内吻合组和腹腔外吻合组在淋巴结清扫范围和吻合方式方面差异有统计学意义（P<0.05），腹腔内吻合组行完整结肠系膜切除（CME）病人比例更高（59.5% vs. 41.8%，P=0.007），且全部行侧侧吻合。两组获取淋巴结数目、术中出血量、手术时间方面差异均无统计学意义（P>0.05）。总体并发症发生率为28.9%（85/294），共115例次。将所有行侧侧吻合的病人（155例）纳入并发症分析，并经分层分析排除淋巴结清扫范围和吻合方式的可能混杂作用后，腹腔内吻合组手术切口感染的发生率高于腹腔外吻合组，差异有统计学意义［18例（20.9%） vs. 3例（4.3%），P=0.012］，而在腹腔感染（含或不含吻合口漏）、吻合口漏、呼吸系统感染、术后肠梗阻、乳糜漏方面差异则无统计学意义（P>0.05）。结论    腹腔镜右半结肠切除术病人中行腹腔内吻合者可能更易发生手术切口感染，应谨慎选择行腹腔内吻合病例。

关键词: 腹腔镜右半结肠切除术, 腹腔内吻合, 腹腔外吻合, 术后并发症

Abstract: A comparative analysis of the short-term complications of intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy        LI Ke-xuan，WU Bin，LIN Guo-le，et al. Division of Colorectal Surgery，Department of General Surgery，Peking Union Medical College Hospital，Chinese Academy of Medical Sciences& Peking Union Medical College，Beijing 100730，China
Corresponding author：XIAO Yi，E-mail：xiaoy@pumch.cn
Abstract    Objective    To compare the occurrence of the short-term complications after intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy. Methods    A total of 294 patients who underwent laparoscopic right hemicolectomy from January 1，2017 to January 7，2021 in Peking Union Medical College Hospital were retrospectively analyzed. 86 cases were classified into intracorporeal anastomosis group and 208 patients were classified into extracorporeal anastomosis group. After eliminating the confounding factors with Cochran-Mantel-Haenszel test, we conducted an analysis focusing on the effect of anastomosis location on postoperative complications such as abdominal infection，anastomotic leak and wound infection. Results    We found that the range of lymphadenectomy (CME versus D2) and anastomotic method differ significantly in the proportion of patient who underwent intra- and extra-corporeal anastomosis (P＜0.05) . More patients underwent complete mesocolic excision in the intracorporeal anastomosis group ［51 cases (59.5%) vs. 87 cases (41.8%)］, and all of which underwent side-to-side anastomosis. There were no significant difference in the lymph node harvest, blood loss during surgery, and duration of operation between the two groups (P＞0.05). The overall incidence of complications was 28.9% (85/294), and 115 cases in total. All the patients who underwent side-to-side anastomosis(155 cases) were included in the complication analysis. After stratification analysis, the incidence of wound infection of intracorporeal anastomosis group were significantly higher than that of extracorporeal anastomosis group ［18 cases (20.9%) vs. 3 cases (4.3%)，P=0.012］，but no statistically significant difference were observed about abdominal infection, anastomotic leak and postoperative bowel obstruction, etc. Conclusion    Among patients undergoing laparoscopic right hemicolectomy, the incidence of wound infection increased significantly in patients with intracorporeal anastomosis. The method of intracorporeal anastomosis should be selected with discretion.

Key words: laparoscopic right hemicolectomy, intracorporeal anastomosis, extracorporeal anastomosis, surgical complications