肠减压后腹腔镜手术治疗右半结肠癌合并急性肠梗阻的临床观察  

Experience of laparoscopic right hemicolectomy after ileal decompression in the management of acute obstructive right-sided colon carcinoma

作　　者：连彦军 宋志岗 范晓斌 胡延伟 范现英 马竞优 甄金朋 杨宁豹 Yanjun Lian;Zhigang Song;Xiaobin Fan;Yanwei Hu;Xianying Fan;Jingyou Ma;Jinpeng Zhen;Ningbao Yang(Department of Gatroenterology Surgery,Xingtai Central Hospital,Xingtai 054000,China)

机构地区：[1]河北邢台市中心医院胃肠外科,054000

出　　处：《中华结直肠疾病电子杂志》2024年第2期129-134,共6页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：河北省卫建委重点科技研究计划(20242163)。

摘　　要：目的探讨腹部辅助小切口回肠减压后再行腹腔镜右半结肠切除手术治疗右半结肠癌合并急性肠梗阻的可行性及近期疗效。方法回顾性分析2017年1月至2022年12月河北邢台市中心医院胃肠外科收治的52例右半结肠癌伴急性肠梗阻患者的临床资料,22例行腹部小切口回肠减压后即刻腹腔镜辅助右半结肠切除(研究组),30例行传统开腹右半结肠切除术(对照组),比较两组患者在手术时间、手术出血量、淋巴结清扫数目、肛门排气时间、住院时间、术后并发症以及炎症指标等方面的变化。结果研究组和对照组两组患者的基本资料具有可比性。与对照组相比,研究组手术出血量少(t=-2.808,P=0.008),术后肛门排气时间快(t=-3.588,P=0.001),手术时间有所延长(t=8.257,P=0.000)。研究组和对照组的淋巴结清扫数目(t=-0.716,P=0.478)、住院时间(t=-0.344,P=0.740)差异无统计学意义。术后近期并发症发生率分别为13.64%和26.67%,差异无统计学意义(χ^(2)=1.292,P=0.256)。研究组和对照组术前IL-6(t=-1.101,P=0.277)、TNF-α(t=1.088,P=0.283)、CRP(t=-1.191,P=0.202)差异均无统计学意义。两组术后上述三项指标水平均高于术前,但研究组升高程度低于对照组,研究组和对照组术后IL-6(t=-4.340,P<0.001)、TNF-α(t=-6.686,P<0.001)、CRP(t=-5.930,P<0.001)差异具有统计学意义。结论对右半结肠癌合并急性肠梗阻患者于回肠减压后即刻行腹腔镜辅助右半结肠切除术一期肠吻合,能有效解决腹腔镜操作空间受限问题,并减少术中出血、促进术后胃肠功能、减轻机体的炎症反应,具有一定临床价值。ObjectiveTo evaluate the feasibility and safety of laparoscopic right hemicolectomy after intestinal decompression through a small abdominal incision in the management of acute obstructive right-side colon carcinoma.MethodsTwenty-two patients who underwent laparoscopic right hemicolectomy after ileal decompression through small abdominal incision due to acute obstructive right- side colon carcinoma (the study group) were retrospectively matched with thirty patients scheduled for a conventional open right hemicolectomy (the control group) during the same period from January 2017 to December 2022. The operation time, blood loss, number of dissected lymph node, the time of anal exhaust, the duration of hospitalization, postoperative complications and levels of serum inflammatory factors were compared between the two groups.ResultsThere was no significant difference in clinic data between the two groups. Compared with the control group, the study group had less blood loss (t=-2.808, P=0.008) and faster anal exhaust time (t=-3.588, P=0.001), longer operation time (t=8.257, P=0.000). The number of dissected lymph nodes (t=-0.716, P=0.478), and the duration of hospitalization (t=-0.344, P=0.740) in the study group and the control group were with no significent difference. There was no significant difference in short-term postoperative complications (χ^(2)=1.292, P=0.256) between the study group (13.64%) and the control group (26.67%). The levels of IL-6 (t=-1.101, P=0.277), TNF-α (t=1.088, P=0.283) and CRP (t=-1.191, P=0.202) in the study group and the control group before operation were with no significant difference. The levels of the above three indexes in the two groups were higher after surgery than before surgery, but the increase degree in the study group was lower than that in the control group. There were statistically significant differences in IL-6 (t=-4.340, P<0.001), TNF-α (t=-6.686, P<0.001) and CRP (t=-5.930, P<0.001) between the study group and the control group.ConclusionLaparoscopic right hemicolect

关 键 词：结肠肿瘤 右半结肠癌 腹腔镜结肠切除 肠梗阻 肠减压 

分 类 号：R735.35[医药卫生—肿瘤]