腹腔镜右结肠切除术中体外手工缝合与体内机械吻合

背景和目标：
比较体外手工缝合侧对侧等蠕动回结肠吻合术 (EHSIA) 与体内机械侧对侧等蠕动回结肠吻合术 (IMSIA) 在腹腔镜下腺癌右半结肠切除术中的结果。

方法：
这是对前瞻性收集的数据进行的回顾性倾向得分匹配分析。 根据患者的人口统计学和手术类型（标准右半结肠切除术或扩大右半结肠切除术），将 54 名接受 EHSIA 手术的患者（干预组）与 54 名接受 IMSIA 手术的患者（对照组）配对。

结果：
每组包括 54 名患者。 在患者的人口统计学和手术类型方面未观察到组间的统计学显著差异。 由于先前手术的腹腔粘连，干预组中有 3 名患者发生了转换 (5.6%) (p = 0.079)。 与干预组相比，对照组的中位手术时间在统计学上显著缩短（分别为 85 分钟和 117.5 分钟，p ≤ 0.0001）。 两组均观察到一处吻合口漏 (1.9%)（Clavien-Dindo III-a 级）。 在对照组中，一名患者 (1.9%) 因术后急性贫血（Clavien-Dindo III-b 级）接受了再干预。 在干预组和对照组中，收获淋巴结的中位数分别为 17 和 12 (p ≤ 0.0001)。 与干预组相比，对照组的中位住院时间在统计学上显著降低（分别为 5 天和 6.5 天，p ≤ 0.013）。

结论：
与 EHSIA 相比，IMSIA 的手术时间和住院时间更短。 需要进一步的随机研究来得出关于腹腔镜右半结肠切除术中最佳吻合技术的明确结论。

腹腔镜右结肠切除术中体外手工缝合与体内机械吻合

体外手工缝合等蠕动回结肠吻合术 (EHSIA) 技术。 1) 回肠和结肠通过一排 vicryl 2.0 单针并排接近、等蠕动。 2) 在一排单针上方，用冷刃手术刀切开结肠和回肠。 3) 将 vicryl 2.0 中的两个针脚放置在吻合口后壁的中间，并将它们的尾巴绑在一起。 4) 两针作为半连续缝合，从吻合口后壁的中部开始一直缝合到吻合口的前壁。 5) 两根缝合线在吻合口前壁中央系在一起。 6) 在吻合上方创建了另一排 vicryl 2.0 单针。

腹腔镜右结肠切除术中体外手工缝合与体内机械吻合

体内机械侧对侧等蠕动回结肠吻合术 (IMSIA) 技术。 回肠和结肠从一侧到另一侧接近，等蠕动，并通过单极透热疗法在每一侧进行肠切开术（步骤 1）。 体内机械吻合是用线吻合器（60 毫米紫色墨盒）进行的（步骤 2）。 为了减少吻合口张力，在吻合口后面的回肠和结肠之间放置 vicryl 2.0 缝线（步骤 3）。 使用具有可吸收 2.0 倒刺缝合线的两条连续缝合线（V-locTM，Medtronic，Minneapolis，Minnesota，USA）关闭肠切开术。 第一个连续缝合线放置在肠切开术的上部，并作为将其固定在腹壁腹膜上的吻合术的牵引力（第 4 步）。 第二个连续缝合线放置在肠切开术的下部以完成其闭合（步骤 5）。 之后，将两条连续缝线系在它们之间（步骤 6）。

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