α-氰基丙烯酸酯医用胶在腹腔镜结直肠癌根治术中关闭肠系膜裂隙的临床研究

Application of α-cyanoacrylate medical glue for mesenteric fissure closure during laparoscopic radical resection of colorectal cancer

摘要:

背景与目的 在腹腔镜结直肠癌根治术中，是否关闭肠系膜裂隙存在争议。未闭合肠系膜裂隙可能增加术后腹内疝和肠梗阻的发生。关闭肠系膜裂隙可能会增加手术时间和难度，甚至增加医源性肠系膜血管损伤风险。为探索更便捷、安全有效的肠系膜裂隙闭合方法，本研究评估α-氰基丙烯酸酯医用胶在腹腔镜结直肠癌根治术中关闭系膜裂隙的临床效果。方法 回顾性分析2022年1月—2023年12月在中山大学附属第六医院结直肠外科接受腹腔镜结直肠癌根治术的患者。先纳入78例术中使用α-氰基丙烯酸酯医用胶关闭肠系膜裂隙的患者为观察组，采用倾向性评分匹配方法选取同期未行裂隙关闭的患者74例作为对照组。比较两组围手术期相关指标、术后恢复及并发症发生情况。结果 两组术前基线资料及主要术中指标差异均无统计学意义（均P>0.05）。观察组术后3 d内腹水引流量明显少于对照组［（203.14±116.44）mL vs.（384.53±243.89）mL，P<0.01］；术后排气、排便及拔除引流管时间均明显缩短（均P<0.01）；两组术后并发症及肠梗阻发生率差异无统计学意义（均P>0.05）。多因素分析提示，术中应用α-氰基丙烯酸酯医用胶是术后3 d内排气的独立促进因素（OR=5.739，P=0.000）。结论 在腹腔镜结直肠癌根治术中应用α-氰基丙烯酸酯医用胶关闭肠系膜裂隙安全可行，能有效减少术后腹水引流量、促进肠道功能恢复。为临床提供一种简便、可靠的替代闭合方式。

Abstract:

Background and Aims Whether to close mesenteric fissures during laparoscopic radical resection of colorectal cancer remains controversial. Traditional suture closure is technically demanding and may injure mesenteric vessels. This study aimed to evaluate the safety and efficacy of using α-cyanoacrylate medical glue to close mesenteric fissures during laparoscopic colorectal cancer surgery.Methods A retrospective analysis was conducted on patients who underwent laparoscopic radical resection of colorectal cancer in the Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, from January 2022 to December 2023. Seventy-eight patients who received intraoperative α-cyanoacrylate glue closure of mesenteric fissures were included as the observation group, and 74 patients without fissure closure were selected as the control group using the propensity score matching method. Perioperative parameters, postoperative recovery, and complications were compared between the two groups.Results No significant differences were observed in baseline characteristics or main intraoperative variables between groups (all P>0.05). The observation group had significantly less ascitic drainage within 3 days after operation [(203.14±116.44) mL vs. (384.53±243.89) mL, P<0.01] and shorter postoperative gas passage, defecation, and drainage tube removal times (all P<0.01). The incidence of postoperative complications and intestinal obstruction was comparable between groups (all P>0.05). Multivariate analysis showed that intraoperative application of α-cyanoacrylate glue was an independent promoting factor for intestinal exhaust within 3 days after surgery (OR=5.739, P=0.000).Conclusion The use of α-cyanoacrylate medical glue for closing mesenteric fissures during laparoscopic radical resection of colorectal cancer is safe and feasible. It effectively reduces postoperative ascitic drainage and accelerates bowel recovery, offering a simple and reliable alternative to traditional suture closure.