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目的:比较扩大左半结肠切除术中不同结直肠吻合方式的近期疗效。方法:回顾性分析2000年7月—2013年8月实施的扩大左半结肠切除术28例临床资料,根据吻合方式不同分为传统组(15例)和改良组(13例),传统组行常规小肠前结直肠吻合术;改良组行经小肠系膜(8例)或小肠系膜后(5例)直肠吻合术。比较两组的术中、术后指标。结果:两组手术时间、术中出血量差异无统计学意义(P>0.05),改良组术后平均排气时间、术后恢复正常饮食时间、住院时间均短于传统组(P<0.05);改良组术后总并发症发生率明显低于传统组(23.1%vs.46.7%,P<0.05),其中主要差异在于高位小肠梗阻发生率(26.7%vs.0.0%,P<0.05)。结论:扩大左半结肠切除术中,采用经小肠系膜和小肠系膜后结直肠吻合术能减少吻合口张力,避免压迫空肠,术后疗效明显优于小肠前结直肠吻合术。
OBJECTIVE: To compare the short-term effects of different colorectal anastomoses in expanding left-hilumectomy. Methods: The clinical data of 28 patients who underwent extended left colectomy from July 2000 to August 2013 were retrospectively analyzed. According to the different anastomosis methods, the patients were divided into the traditional group (15 cases) and the modified group (13 cases) Conventional pre-small bowel anastomosis; modified group through the small mesentery (8 cases) or small mesenteric (5 cases) rectal anastomosis. The intraoperative and postoperative indexes of the two groups were compared. Results: There was no significant difference in operative time and intraoperative blood loss between the two groups (P> 0.05). The average postoperative exhaust time, normal diet and hospital stay after operation were shorter than those in the traditional group (P <0.05) . The incidence of postoperative complications in the modified group was significantly lower than that in the traditional group (23.1% vs 46. 6%, P <0.05). The main difference was the incidence of high intestinal obstruction (26.7% vs.0.0%, P <0.05). Conclusions: In the course of expanding the left hemilaminectomy, the small intestine and small mesenteric colorectal anastomosis can reduce the anastomotic tension and avoid compressing the jejunum. The postoperative curative effect is obviously superior to the small intestine anastomosis.