Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy
Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy
复制标题
DOI：
10.1007/s00464-009-0865-9
复制
发表时间：
2010-08-01
影响因子：
3.1
通讯作者：
Salky, Barry
中科院分区：
文献类型：
--
作者：
Grams, Jayleen;Tong, Winnie;Salky, Barry
与开放性切除术相比，腹腔镜辅助结肠切除术可使肠功能更早恢复、术后疼痛减少、住院时间缩短和发病率降低。腹腔镜辅助的半结肠切除术通常仍然涉及肠外化以进行切除和吻合。本研究的目的是确定在腹腔镜辅助下半结肠切除术中进行内切除和吻合与体外切除和吻合的短期结局，回顾性分析了2006年1月至2008年8月期间由一名外科医生进行腹腔镜辅助下半结肠切除术或结肠切除术的105例连续患者。共105例患者接受了腹腔镜辅助回结肠切除术（66例）、右半结肠切除术（29例）、左半结肠切除术（9例）和结肠次全切除术（1例）。体外循环组中男性较多，但两组中的患者在人口统计学上相似。在54例患者中进行了髓内吻合，在51例患者中进行了体外吻合。颅内组的手术时间较长（p <0.001），但估计失血量较少（p = 0.014）。术后，肠内吻合组和体外吻合组之间的排便时间无显著差异;但是，排气时间较早（分别为2天和2.4天; p = 0.017）。术中组与体外组相比，术后麻醉剂使用（16与49 mg吗啡当量; p = 0.001）、住院时间（3.2与3.8天; p = 0.012）和围手术期发病率（6与15例患者; p = 0.019）均有所降低。与体外技术相比，切除并在体内建立吻合口可产生上级效果，肠功能恢复更早，术后麻醉剂使用减少，住院时间和发病率降低。需要进一步的研究来验证我们的发现。
Laparoscopic-assisted colon resection has been shown to result in earlier return of bowel function, decreased postoperative pain, decreased length of stay, and decreased morbidity when compared to open resection. Laparoscopic-assisted hemicolectomy often still involves externalization of the bowel for resection and anastomosis. The aim of this study was to determine short-term outcomes of performing intra- versus extracorporeal resection and anastomosis in laparoscopic-assisted hemicolectomy.Retrospective chart review of 105 consecutive patients who underwent laparoscopic-assisted hemicolectomy or colectomy by a single surgeon from January 2006 through August 2008 was performed. Pearson chi(2) and Student's t test were used to test for significance.There were 105 patients in total who underwent laparoscopic-assisted ileocolic resection (66), right hemicolectomy (29), left hemicolectomy (9), and subtotal colectomy (1). There were more males in the extracorporeal group, but patients in the two groups were otherwise demographically comparable. An intracorporeal anastomosis was performed in 54 patients and extracorporeal in 51 patients. The operation was longer in the intracorporeal group (p a parts per thousand currency sign 0.001), but estimated blood loss was less (p = 0.014). Postoperatively, there was no significant difference in time to bowel movement between the intra- and extracorporeal anastomosis groups; however, there was earlier return of flatus (2 vs. 2.4 days, respectively; p = 0.017). Postoperative narcotic use (16 vs. 49 mg morphine equivalents; p = 0.001), length of stay (3.2 vs. 3.8 days; p = 0.012), and perioperative morbidity (6 vs. 15 patients; p = 0.019) were all decreased in the intra- versus extracorporeal group, respectively. There was no perioperative mortality.In comparison to the extracorporeal technique, resection and creation of the anastomosis intracorporeally produces superior results with earlier return of bowel function, decreased postoperative narcotic use, and decreased length of stay and morbidity. Further studies will be needed to verify our findings.