摘要
目的 探究三种不同的腹腔镜手术时机对结肠镜下支架置入术后择期腹腔镜治疗结直肠癌合并肠梗阻患者疗效的影响。方法 收集2017年6月至2019年6月上海中医药大学附属曙光医院收治的98例结直肠癌合并肠梗阻患者资料进行回顾性分析,所有患者均行结肠镜下支架置入术解除肠梗阻,在患者解除梗阻、肠道功能恢复、纠正水电解质紊乱以及耐受手术后行腹腔镜手术。根据择期腹腔镜的不同手术时机将98例患者分为A组(n=28)、B组(n=40)以及C组(n=30)。A组患者为结肠镜下支架置入术术后2~6 d行腹腔镜手术,B组患者为结肠镜下支架置入术术后7~11 d行腹腔镜手术,C组患者为结肠镜下支架置入术术后11 d以后行腹腔镜手术。比较三组患者的手术情况、围手术期情况(包括术中出血量、手术时间、淋巴结清扫数量、住院时间、术后肛门排气时间)以及术后并发症情况。结果三组患者结肠镜下支架置入术均成功置入支架并解除梗阻,无肠管穿孔及大量出血患者。三组手术均获成功,且均无中转开腹手术及死亡情况。三组患者术中出血量(A组:60. 58±18. 44 ml,B组:57. 40±15. 67 ml,C组:56. 00±14. 94 ml)、手术时间(A组:116. 36±35. 41 min,B组:117. 54±35. 87 min,C组:120. 04±36. 05 min)、淋巴结清扫数量(A组:11. 80±3. 21枚,B组:11. 64±3. 13枚,C组:11. 64±3. 13枚)、住院时间(A组:5. 80±1. 52 d,B组:5. 61±1. 43d,C组:5. 58±1. 40 d)、术后肛门排气时间(A组:1. 58±0. 07 d,B组:1. 55±0. 07 d,C组:1. 56±0. 06 d)比较,差异无统计学意义(P> 0. 05)。三组患者总并发症发生率(A组:14. 29%,B组:12. 50%,C组:16. 67%)比较,差异无统计学意义(P> 0. 05)。结论 结直肠癌合并肠梗阻患者行结肠镜下支架置入术后择期进行腹腔镜手术治疗安全可行。择期腹腔镜手术时机选择对疗效的影响无显著差异,主要依据患者肠道恢复情况、手术耐受情况而定。
Objective To explore the effect of three different laparoscopic surgical procedures on the efficacy of elective laparoscopic treatment of colorectal cancer with intestinal obstruction after colonoscopy.Methods A retrospective analysis was performed on 98 cases of colorectal cancer with intestinal obstruction collected from June 2017 to June 2019 in the Shanghai University of Traditional Chinese Medicine Affiliated Shuguang Hospital.All patients underwent colonoscopic stenting to relieve intestinal obstruction,and laparoscopic surgery was performed after removal of obstruction recovery of intestinal function,correction of water and electrolyte disorders and tolerance to surgery.According to the different operative timing of laparoscopic surgery,98 patients were divided into group A(n=28),group B(n=40)and group C(n=30).Patients in group A underwent laparoscopic surgery after 2~6 days of colonoscopic stenting,group B underwent laparoscopic surgery after 7~11 days of colonoscopic stenting,and group C underwent laparoscopic surgery after 11 days of colonoscopic stenting.The operative conditions,intraoperative bleeding volume,operative time,number of lymph nodes dissection,hospitalization time,postoperative anal exhaust time and postoperative complications were compared among the three groups.Results In the three groups of patients,the stent placement was successfully placed in the stent and the obstruction was removed,and there was no perforation of the intestinal tube and no large number of patients with bleeding.Surgery of all three groups were successful,and none of the patients had trans-laparotomy or death.The amount of blood loss in three groups(group A:60.58,18.44 ml,group B:57.40~15.67 ml,group C:56.00~14.94 ml),operation time(group A:116.36±35.41 min,group B:117.54±35.87 min,group C:120.04±36.05 min),the number of lymph node dissection(group A:11.80±3.21,group B:11.64±3.13,group C:11.64±3.13),hospitalization time(group A:5.80~1.52 d,group B:5.61~1.43 d,group C:5.58-1.40 d)and postoperative anal anal exsufflation time(group A:1.58±0.07 d,group B:1.55±0.07 d,group C:1.56±0.06 d)had no significant difference among the three groups(P>0.05).There was no significant difference in the incidence of total complications(group A:14.29%,group B:12.50%,group C:16.67%)among the three groups(P>0.05).Conclusion Laparoscopic surgery is safe and feasible for colorectal cancer patients with intestinal obstruction after colonoscopic stenting.There was no significant difference in the timing of laparoscopic surgery,which was mainly based on the recovery of intestinal tract and lerance to surgery.
作者
曹羽
龚航军
韩刚
张云
张言言
CAO Yu;GONG Hang-jun;HAN Gang(Department of Gastrointestinal Surgery,Shanghai University of Traditional Chinese Medicine Affiliated Shuguang Hospital,Shanghai 201203,China)
出处
《临床和实验医学杂志》
2019年第24期2676-2678,共3页
Journal of Clinical and Experimental Medicine
基金
上海市卫生和计生委科研课题计划项目(编号:20154Y0140)
关键词
结直肠癌合并肠梗阻
手术时机
支架置入术
结肠镜
腹腔镜
临床疗效
Colorectal cancer complicated with intestinal obstruction
Operative timing
Stent implantation
Colonoscopy
Laparoscopy
Clinical efficacy
