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。
Comparison of short-term outcomes of different techniques of colorectal anastomosis in extended left hemicolectomy
Objective: To compare the short-term outcomes of different techniques of colorectal anastomosis in extended left hemicolectomy. Methods: The clinical and follow-up data of 28 patients who underwent extended left colectomy from July 2000 to August 2013 were retrospectively analyzed. The patients were classified into conventional group (15 cases) and modified group (13 cases) according to the approaches used for colorectal anastomosis. Patients in conventional group underwent conventional colorectal anastomosis anterior to the small intestine, and those in modified group underwent colorectal anastomosis through the mesentery of the small intestine (8 cases) or posterior to the mesentery of the small intestine (5 cases). The intra- and postoperative variables between the two groups were compared. Results: There was no significant difference in operative time and intraoperative blood loss between the two groups (both P>0.05), but the average time to flatus and oral food intake, and length of postoperative hospital stay were shorter in modified group compared with conventional group (all P<0.05). The incidence of overall postoperative complications in modified group was significantly lower than that in conventional group (23.1% vs. 46.7%, P<0.05), where the main difference was due to the incidence of high-level small intestinal obstruction (26.7% vs. 0.0%, P<0.05). Conclusion: In extended left colectomy, using colorectal anastomosis through or posterior to the mesentery of the small intestine can decrease the tension at the anastomotic stoma, and avoid jejunal compression, and its efficacy is superior to that using anastomosis anterior to the small intestine.