梗阻性左半结直肠癌自膨式金属支架置入后行腹腔镜手术与开腹手术的短期临床疗效比较  

Short-term clinical outcomes of laparoscopic versus open surgery after self-expansion metallic stent placement for obstructive left-sided colorectal cancer

作　　者：张迪 王春霞 张学东 李发馨 庞淅文 陈一锋 张维胜[2] 王涛[2] Zhang Di;Wang Chunxia;Zhang Xuedong;Li Faxin;Pang Xiwen;Chen Yifeng;Zhang Weisheng;Wang Tao(The First Clinical Medical College of Gansu University of Chinese Medicine,Lanzhou 730000,China;Department of Anorectal,Gansu Provincial People's Hospital,Lanzhou 730000,China)

机构地区：[1]甘肃中医药大学第一临床医学院,兰州730000 [2]甘肃省人民医院肛肠科,兰州730000

出　　处：《中华结直肠疾病电子杂志》2024年第5期375-380,共6页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家自然科学基金项目(No.82160522);甘肃省科技厅联合科研基金一般项目(No.23JRRA1540);兰州市科技人才创新项目(No.2023-QN-17);兰州市科技计划项目(No.2022-5-68)。

摘　　要：目的比较梗阻性左半结直肠癌患者置入自膨式金属支架后行腹腔镜手术或开腹手术的短期临床疗效。方法回顾性分析2016年6月至2024年6月在甘肃省人民医院肛肠科就诊的梗阻性左半结直肠癌患者的临床病例资料。纳入成功置入支架且行根治性手术的患者,根据手术方式的不同,分为腹腔镜手术组和开腹手术组,比较两组之间的短期临床疗效。结果共纳入患者64例,腹腔镜手术组35例,开腹手术组29例。两组患者在性别、年龄、BMI、肿瘤大小、T分期、TNM分期、ASA分级和是否行新辅助治疗方面差异无统计学意义(P>0.05)。两组患者的术中和术后情况相比,腹腔镜手术组的术中出血量(t=-3.004,P=0.008)、术后排气时间(t=-2.333,P=0.031)、术后进食时间(t=-2.240,P=0.038)、术后住院时间(t=-2.418,P=0.030)、术后首次化疗时间(t=-3.430,P=0.003)、Ⅰ期切除吻合率(χ^(2)=5.823,P=0.016)均优于开腹手术组,差异均具有统计学意义;腹腔镜手术组与开腹手术组在手术时间、清扫淋巴结数目、30天死亡例数方面差异无统计学意义(P>0.05)。腹腔镜手术组的术后早期并发症(伤口感染、吻合口漏、腹腔内脓肿、肺炎、其他并发症)发生率低于开腹手术组,总体差异具有统计学意义(χ^(2)=4.932,P=0.026)。结论对于梗阻性左半结直肠癌患者,自膨式金属支架置入联合腹腔镜手术能改善患者的术中和术后情况,降低了早期并发症发生率,因此其短期治疗效果优于开腹手术。Objective To compare the short-term clinical efficacy observation of laparoscopic surgery or open surgery after placement of self-expandable metal stent in patients with obstructive leftsided colorectal cancer.Methods Clinical case data of patients with obstructive left-sided colorectal cancer who attended the Department of Anorectology of Gansu Provincial People's Hospital from June 2016 to June 2024 were retrospectively analyzed.Patients who were successfully stented and underwent radical surgery were included,and according to the different surgical methods,they were divided into the laparoscopic surgery group and the open surgery group to compare the short-term clinical efficacy between the two groups.Results A total of 64 patients were included,thirty-five in the laparoscopic surgery group and 29 in the open surgery group.There was no statistically significant difference between the two groups in terms of gender,age,BMI,tumor size,T stage,TNM stage,ASA grade and whether neoadjuvant therapy was performed(P>0.05).Compared with the intraoperative and postoperative conditions of patients in the two groups,the laparoscopic surgery group showed no significant differences in intraoperative bleeding(t=-3.004,P=0.008),postoperative time to exhaustion(t=-2.333,P=0.031),postoperative time to feeding(t=-2.240,P=0.038),postoperative hospitalization time(t=-2.418,P=0.030),time to first postoperative chemotherapy(t=-3.430,P=0.003),and stage I resection anastomosis(χ^(2)=5.823,P=0.016)were better than those in the open surgery group,and the differences were all statistically significant;there was no statistically significant difference between laparoscopic surgery group and the open surgery group in terms of operation time,number of lymph nodes discharged,and death at 30 days(P>0.05).The incidence of early postoperative complications(wound infection,anastomotic leakage,intra-abdominal abscess,pneumonia,and other complications)was lower in the laparoscopic surgery group than in the open surgery group,and the overall dif

关 键 词：结直肠肿瘤 肠梗阻 自膨式金属支架 腹腔镜手术 开腹手术 

分 类 号：R735.35[医药卫生—肿瘤]