腹腔镜与开腹结直肠癌根治术术后早期炎症性肠梗阻的防治

The prevention and treatment of early stage postoperative inflammatory intestinal obstruction after laparoscopic and open radical resection of colorectal carcinoma

目的探讨腹腔镜与开腹结直肠癌根治术术后早期炎症性肠梗阻（early postoperative inflammatory intestinal obstruction，EPIIO）的发生率、发病原因。方法对照同期同一组医师连续实施的232例腹腔镜结直肠癌根治术与251例开腹结直肠癌根治术，比较术后早期肠梗阻发病率及防治差异。结果LS组中转开腹14例，中转开腹率为5．69％（14／246）；LS组术后EPIIO的发病率为3．02％（7／232），6例保守治愈，1例手术治愈，OS组术后EPIIO的发病率为7．97％（20／251），18例保守治愈，2例手术治愈，且均行小肠排列术，两组EPIIO的发生率差异有统计学意义（χ^2=5．60，P〈0．05）。结论腹腔镜手术可减少EPIIO的发生率；EPIIO应以保守治疗为主，当病情反复或出现肠绞窄表现时应及时手术治疗。

Objective To investigate the incidence, cause, prevention and treatment of early postoperative inflammatory intestinal obstruction （EPIIO） in patients undergoing laparoscopic and open radical resection of colorectal cancer. Methods From September 2000 to September 2006, 483 cases of colorectal cancer were divided into two groups according the procedures received： laparoscopic surgery （232 cases） and open surgery （251 cases）. The incidence of early postoperative intestinal obstruction was compared between the two groups. Results 1. In laparoscopic group, 14 cases （5.69%, 14/246 ） were converted to open surgery; 2. The incidences of EPIIO in LS and OS group were respectively 3.02% （7/ 232 ） and 7. 97% （20/251 ） （P 〈 0. 05, χ^2 = 5.60）. In LS group, 6 EPIIO cases were cured conservatively, one underwent surgery, while in open surgery group, 18 cases recovered conservatively, two received surgery. Conclusions 1. Significantly less cases suffered from EPIIO in laparoscopic group. 2. Most EPIIO cases will recover conservatively, in cases with repeated symptoms or when strangulation of bowel is suspected open surgery should be attempted.