结直肠支架序贯联合腹腔镜手术在左半结肠癌伴肠梗阻中的应用  

Application of sequential combination of colorectal stents and laparoscopy in left colon cancer with intestinal obstruction

作　　者：吕国恩 邹文书[1] 梁宇通 陈秋连[1] 谭翠[1] 孔刚[2] Lyu Guo’en;Zou Wenshu;Liang Yutong;Chen Qiulian;Tan Cui;Kong Gang(Endoscopy Center,Jiangmen Central Hospital,Department of Gastrointestinal Surgery, Jiangmen Central Hospital,Jiangmen 529030,Chin)

机构地区：[1]广东省江门市中心医院窥镜中心,529030 [2]广东省江门市中心医院胃肠外科,529030

出　　处：《中华普通外科学文献（电子版）》2018年第3期165-169,共5页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的探讨结直肠支架联合腹腔镜根治手术治疗左半结肠癌伴肠梗阻患者的临床有效性及安全性。方法回顾性分析2012年1月至2016年12月江门市中心医院收治的可根治性切除左半结肠癌伴肠梗阻患者90例,根据治疗方式不同分为联合治疗组(33例,先行肠道支架置入术后行腹腔镜下一期切除吻合术)和单纯手术组(57例,行急诊开腹手术)。对比分析两组患者的临床成功率、安全性和疗效。结果联合治疗组中3例导丝无法通过狭窄处而放置肠道支架失败,未出现支架置入相关的穿孔、支架移位、出血及术后肠穿孔,技术成功率及临床成功率均为90.9%(30/33)。30例术后3~5 d均顺利施行腹腔镜下肿瘤根治术而不需施行预防性肠道造瘘术。联合治疗组以及单纯手术组的平均手术时间分别为(274.6±58.4)min、(294.3±54.2)min,两组比较差异无统计学意义(t=1.569,P=0.120)。联合治疗组术中出血量为(35.4±20.4)ml,明显低于单纯手术组的(135.5±26.9)ml,差异有统计学意义(t=17.84,P<0.001)。两组患者均未发生围手术期死亡,总体并发症、感染性并发症、非感染性并发症发生率均差异无统计学意义。结论结直肠支架在左半结肠癌伴肠梗阻中的应用安全、有效。结直肠支架可作为腹腔镜根治手术术前准备的"桥梁",并发症发生率低,避免预防性肠道造口,临床短期疗效相近。Objective To explore the clinical efficacy and safety of colorectal stents combined with laparoscopic radical surgery for left colon cancer with intestinal obstruction. Methods A retrospective analysis of ninety patients with radical resection of left colon cancer with intestinal obstruction from January 2012 to December 2016 in Jiangmen Central Hospital was carried out. Patients were divided into two groups according to the treatment method： combined treatment group（33 cases, received early enteric stent implantational sequence with first-stage laparocopic resection and anastomosis） and simple operation group（57 cases, underwent emergency operation）. Clinical success rates, safety, and surgical outcomes were compared between two groups. Results In the combined treatment group, 3 cases failed to place the stent through the stenosis. No patient had stent implantation related perforation, stent displacement, bleeding or postoperative intestinal perforation. The technical success rate and clinical success rate were both 90.9%（30/33）. Laparoscopic radical resection was performed in 30 cases 3-5 d after stenting without prophylactic intestinal stoma. The average operation time of the combined treatment group and the simple operation group was（274.6±58.4） min and（294.3±54.2） min, with no statistically significant difference（t=1.569, P=0.120）. The amount of bleeding in the combined treatment group was significantly lower than that of the simple operation group [（35.4±20.4） ml vs（135.5±26.9） ml, t=17.84, P〈0.001]. No patient died during the perioperative period. There were no significant differences in overall complications, infectious complications, and non-infectious complications between the two groups. Conclusion As a pre-operative ＂bridge＂ for laparoscopic radical surgery, the application of colorectal stents in left colon cancer with intestinal obstruction is safe and effective, with acceptable complication rate, similar clinical short-term outcome, and preventive enteros

关 键 词：结肠肿瘤 肠梗阻 支架 腹腔镜 

分 类 号：R735.35[医药卫生—肿瘤]