肠道支架置入联合腹腔镜手术治疗结直肠癌并梗阻的临床研究

Clinical research of colonic stent insertion combined with laparoscopic resection in treatment of obstructive colorectal cancer

摘要:

探讨肠道支架置入联合腹腔镜手术治疗结直肠癌并梗阻的临床价值。方法 回顾性分析2014年1月－2016年9月在九江市第一人民医院住院的72例确诊为急性左半结肠及直肠癌并梗阻的患者，其中35例行肠道支架置入联合腹腔镜手术治疗（联合组），37例行传统开腹手术加术中肠腔冲洗（传统组），比较两组患者的临床指标。结果 两组术前资料具有可比性，肠镜下支架置入成功率100.0%，临床缓解率100.0%。与传统组相比，联合组在手术时间（145.42 vs 200.25 min）、切口长度（4.52 vs 16.21 cm）、术中出血量（51.41 vs 215.24 ml）、清扫淋巴结数（17.24 vs 13.41枚）、术后住院时间（8.52 vs 11.50 d）和二期手术率（2.9% vs 24.3%）方面均有明显优势，差异均有统计学意义（P <0.05）。两组术中肿瘤切除率、术后肛门排气时间、治疗费用和手术并发症比较，差异均无统计学意义（P >0.05）。结论 肠道支架在治疗结直肠癌并梗阻中具有放置成功率高、临床缓解率高等优点；肠道支架置入联合腹腔镜手术治疗结直肠癌并梗阻是一种安全、可行、效果好的方法，能降低二期手术率，值得临床推广。

Abstract:

To assess the clinical value of colonic stent insertion combined with laparoscopic resection in treatment of obstructive colorectal cancer.?Methods?A retrospective analysis of 72 patients with acute left colonic obstruction were selected from January 2014 to September 2016. 35 cases colonic stent insertion combined with laparoscopic resection (combination group), and 37 cases were subjected to conventional open resection plus intraoperative colonic lavage (conventional group). Clinical indicators were compared between the two groups.?Results?The preoperative data between the two groups of patients were comparable. The success rate of stent placement was 100.00% (35/35) was 100.0%, Clinical remission rate was 100.0%. Compared with conventional group, operative time (145.42 vs 200.25 min), length of incision (4.52 vs 16.21 cm), amount of bleeding during operation (51.41 vs 215.24 ml), number of resected lymph nodes (17.24 vs 13.41), length of postoperative hospital stay (8.52 vs 11.50 d), rate of second-stage surgery (2.9% vs. 24.3%) ( all P < 0.05). There was no statistically significant difference between the two groups in tumor radical resection rate, postoperative anal exhaust time, cost of treatment and surgical complications (all P > 0.05).?Conclusion?Colonic stent has the advantages of high placement success rate and high clinical remission rate in the treatment of colorectal cancer and obstruction; Colonic stent insertion combined with laparoscopic resection for obstructive colorectal cancer is safe and feasible, and it also has ideal radical effects and can reduce the rate of second-stage surgery, and worthy of clinical use.