经内镜支架置入联合腹腔镜手术治疗左侧大肠癌性梗阻的临床价值  

The clinical value of laparoscopic surgery combined with endoscopic stenting for malignant left colorectal obstruction

作　　者：谢德金[1] 王小忠[1] 彭云恒[1] 孙晓丹[1] XIE De-jin WANG Xiao-zhong PENG Yun-heng et al.(Department of General Surgery ,Shantou Central Hospital, Shantou 515031, China)

机构地区：[1]汕头市中心医院,广东汕头515031

出　　处：《腹腔镜外科杂志》2016年第11期832-836,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨经内镜支架置入术联合腹腔镜手术治疗左侧大肠癌性梗阻的临床价值。方法:回顾分析2010年3月至2015年3月收治的44例左侧大肠癌并急性肠梗阻患者的临床资料,其中观察组(n=18)经内镜联合X光置入结肠金属支架,缓解肠梗阻后择期行腹腔镜手术,对照组(n=26)则行术中结肠灌洗、Ⅰ期根治性切除吻合术。对比分析两组手术时间、术中出血量、术后肛门排气时间、手术并发症、住院时间、住院费用等。结果:观察组手术时间、术中出血量、术后肛门排气时间、住院时间明显优于对照组(P<0.01),而住院费用则高于对照组(P<0.01);对照组术后并发症发生率明显高于观察组(P<0.05)。结论:结肠支架置入术可有效解除左侧大肠癌急性肠梗阻,支架置入术后择期行腹腔镜手术安全、可行,患者创伤小,术后康复快,并发症少,是安全有效的治疗手段。Objective： To evaluate the clinical value of laparoscopic surgery combined with endoscopic stenting for malignant left colorectal obstruction. Methods： A total of 44 patients who were diagnosed with acute left colorectal malignant obstruction from Mar.2010 to Mar. 2015 were reviewed. According to patients’ preference,all the cases were divided into two groups： 18 cases received laparoscopic surgery after the placement of self-expanding metal stent（ observation group）,while 26 cases were treated by one-stage radical colon resection after colon irrigation（ control group）. The operative time,blood loss,postoperative ventilation time,operative complications,hospital stay and hospitalization costs were compared between two groups. Results： In observation group,the operative time,intraoperative blood loss,postoperative ventilation time and hospital stay were significantly less than those in control group（ P 〈 0. 01）,hospitalization cost was more expensive than that in control group（ P 〈 0. 01）. The postoperative complications in observation group were significantly less than those in control group（ P 〈 0. 05）. No significant difference was detected between two groups in anastomotic leakage,abdominal infection,postoperative inflammatory ileus,pulmonary complications（ P 〉 0. 05） except incision infection（ P 〈 0. 05）.Conclusions： Endoscopic placement of colorectal stenting can effectively alleviate the malignant left colorectal obstruction. Elective laparoscopic surgery after stenting is safe,feasible and mini-invasive,has advantages of quick postoperative recovery and few complications,can be an effective treatment.

关 键 词：结直肠肿瘤 肠梗阻 支架 腹腔镜检查 

分 类 号：R735.34[医药卫生—肿瘤]