大承气汤联合自膨式金属支架在左半结直肠恶性梗阻治疗中的应用  

Dachengqi Decoction and Self-expandable Metallic Colonic Stent for Left-Sided Malignant Large-bowel Obstruction

作　　者：张帅[1] 杨正多 张巨东 武广海 张诗武[2] 赵永捷[1] 徐靖[1] ZHANG Shuai;YANG Zheng-duo;ZHANG Ju-dong(Basic Surgery Center of Tianjin United Medical Center,Tianjin(300121),China)

机构地区：[1]天津市人民医院基础外科中心,天津300121 [2]天津市人民医院病理科,天津300121

出　　处：《中国中西医结合外科杂志》2021年第5期712-717,共6页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：天津市卫生健康委、天津市中医药管理局中医、中西医结合科研课题(2019122)。

摘　　要：目的:探讨大承气汤联合自膨式金属支架(SEMS)在左半结直肠恶性梗阻(MLBO)治疗中的作用及安全性。方法:选取2018年1月—2020年6月天津市人民医院收治的因MLBO行SEMS治疗的患者78例。随机化分为大承气汤组38例,聚乙二醇组40例。两组患者均进行限期手术治疗,在后续治疗时,大承气汤组口服大承气汤(1袋,125 mL/次,2次/d),聚乙二醇组口服聚乙二醇(舒泰清,A剂+B剂各2袋/次,饮用水冲调至125 mL/次,2次/d),比较2组术前准备时间、腹腔镜率、手术时间、并发症发生率、造口率、排气时间、术后住院时间、淋巴结清扫数目及术后病理水肿程度等差异。结果:大承气汤组的术前准备时间为6(5,7)d,低于聚二乙醇组的8(6,9)d,差异有统计学意义(P<0.001)。大承气汤组限期手术的腹腔镜率为65.8%,高于聚乙二醇组的40.0%,差异有统计学意义(P=0.023)。大承气汤组在造口率(21.1%vs 50.0%)及并发症发生率(15.8%vs 40.0%)方面亦优于聚乙二醇组(均P<0.05)。两组的淋巴清扫数目无明显差异(P=0.2),但大承气汤组的病理组织水肿程度比聚乙二醇组轻,差异有统计学意义(P=0.043)。结论:大承气汤可有效提高MLBO放置SEMS后限期手术的肠道准备效率及质量,提高腹腔镜成功率,并明显降低限期手术并发症发生率及造口率。Objective The aim of this study was to analyze short-term outcomes and safety of Dachengqi decoction and self-expandable metallic colonic stent(SEMS)for following limited surgery in left-sided malignant large-bowel obstruction(MLBO).Methods From January 2018 to June 2020,a total of 113 patients with MLBO underwent endoscopic treatment for SEMS at our single institution.According to the inclusion criteria,78 patients of them were identified.All patients were randomly divided to two groups(Dachengqi decoction group,n=38;polyethylene glycol group,n=40).Subsequently,the two groups were treated with limited surgery.The preoperative preparation time,laparoscopic rate,operation time,complication rate,stoma rate,exhaust time and postoperative pathological edema were compared between the two groups.Results The preoperative preparation time of Dachengqi decoction group was 6(5,7)d,while that of the polyethylene glycol group was 8(6,9)d.There were significant differences between the two groups(P<0.001).The laparoscopic rate was 65.8%in the Dachengqi decoction group and 40.0%in the polyethylene glycol group.There were also significant differences between the two groups(P=0.023).In terms of stoma rate(21.1%vs 50.0%)and complication rate(15.8%vs 40.0%),Dachengqi decoction group was also superior to polyethylene glycol group(P<0.05).There was no significant difference in the number of lymph node cleaning between the two groups(P=0.2),but the degree of pathological edema in the Dachengqi decoction group was lower than that of polyethylene glycol group(P=0.043).Conclusions Dachengqi Decoction can effectively improve the quality and efficiency of bowel preparation for limited surgery after SEMS placement of MLBO,improve the success of laparoscopy and reduce the rate of limited surgery complications and stoma rate.

关 键 词：大承气汤 左半结直肠恶性梗阻 自膨式结肠金属支架 腹腔镜 并发症 

分 类 号：R656.9[医药卫生—外科学]