改良肠梗阻导管置入联合腹腔镜下结直肠癌根治术对急性左半结直肠癌合并恶性肠梗阻的临床效果  

Effect of modified intestinal obstruction catheter combined with laparoscopic radical resection on acute left-sided colorectal malignant obstruction

作　　者：张伟 唐文慧 赵磊 高胜 赵金 ZHANG Wei;TANG Wenhui;ZHAO Lei(Department of General Surgery,Daxing Teaching Hospital,Capital Medical University,Beijing 102699,China;不详)

机构地区：[1]首都医科大学大兴教学医院普外科,北京市102699 [2]首都医科大学大兴教学医院感染内科,北京市102699

出　　处：《河北医药》2024年第20期3120-3123,共4页Hebei Medical Journal

摘　　要：目的探讨腹腔镜下结直肠癌根治术联合改良肠梗阻导管置入在急性左半结直肠癌合并恶性肠梗阻治疗中的应用价值。方法回顾性分析,选取2021年6月至2023年2月首都医科大学大兴教学医院44例未使用改良肠梗阻导管行急性期结直肠癌开腹切除术治疗的急性左半结直肠癌合并恶性肠梗阻患者资料,纳入对照组;另采集同期医院44例改良肠梗阻导管置入联合腹腔镜下结直肠癌根治术治疗的同病患者资料,纳入观察组。患者各资料保存完整,查阅并记录研究所需结果资料,包括:术中情况;术后恢复情况、术前及术后3小时免疫功能指标[T淋巴细胞亚群(CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+))]及胃肠激素[胃泌素(GAS)、胃动素(MOT)]、Ⅰ期吻合率及术后并发症发生情况。结果与对照组对比,观察组切口长度短,术中出血量少(P<0.05);2组淋巴结清扫数目、手术时间比较,差异无统计学意义(P>0.05)。与对照组对比,观察组术后首次排气时间、排便时间、术后住院时间均短(P<0.05)。与对照组对比,观察组Ⅰ期吻合率高,术后腹腔内感染以及吻合口瘘发生率均低(P<0.05)。结论改良肠梗阻导管置入联合腹腔镜手术治疗左半结直肠癌合并恶性肠梗阻具有创伤小的优势,对患者免疫功能及胃肠功能影响较小,可促进患者术后恢复,降低腹腔内感染及吻合口瘘发生率。Objective To explore the application value of modified intestinal obstruction catheter combined with laparoscopic radical resection on acute left-sided colorectal malignant obstruction.Methods In this retrospective analysis,total 88 patients with acute left-sided colorectal malignant obstruction visited Daxing Teaching Hospital,Capital Medical University from June 2021 to February 2023 were included,and they were randomized to laparoscopic radical resection(control group,n=44)or modified intestinal obstruction catheter combined with laparoscopic radical resection(observation group,n=44).The patient’s data were kept intact,and the results of the study were reviewed and recorded.The key observation was intraoperative conditions,postoperative recovery,preoperative and postoperative immune function indexes including T lymphocyte subsets(CD_(3)^(+),CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+))and gastrointestinal hormones including gastrin(GAS),motilin(MOT),primary anastomosis rate and postoperative complications.Results Compared with the control group,the observation group had significantly shorter incision length and less intraoperative blood loss(P<0.05).The number of lymph node dissection and operation time were similar between the two groups(P>0.05).The first exhaust time,defecation time and postoperative hospital stay in the observation group were significantly shorter than those in the control group(P<0.05).Compared with the control group,the observation group had significantly higher rate of primary anastomosis,and lower incidence of postoperative intra-abdominal infection and anastomotic leakage(P<0.05).Conclusion The combination of modified intestinal obstruction catheter placement and laparoscopic surgery for the treatment of acute left-sided colorectal malignant obstruction has the advantage of minimal trauma,minimal impact on the patient’s immune and gastrointestinal functions,promoting postoperative recovery,and reducing the incidence of intra-abdominal infection and anastomotic fistula.

关 键 词：左半结直肠癌 恶性肠梗阻 改良肠梗阻导管 腹腔镜 并发症 

分 类 号：R735.3[医药卫生—肿瘤]