结肠镜联合腹腔镜治疗左半结肠癌梗阻的临床研究

Laparoscopy and colonoscopy for left-sided colonic carcinoma with acute bowel obstruction

目的评价结肠镜辅助下术前经肛门置管减压，以及在腹腔镜下左半结肠癌一期切除、吻合的疗效，探讨左半结肠癌伴肠梗阻的治疗选择。方法2004年12月至2007年8月治疗11例左半结肠癌伴肠梗阻：（1）在结肠镜辅助和X线指引下经肛门将肠梗阻导管置入梗阻部位的近端肠管进行减压，观察患者症状缓解情况、肠鸣音、腹围、腹腔内压力、腹平片等的变化，评价肠梗阻的治疗效果；（2）肠梗阻缓解后，经常规术前准备后行择期腹腔镜左半结肠癌一期切除、吻合。结果（1）置管减压5～14d后，11例患者的肠梗阻症状均有缓解，避免了急诊手术；（2）11例患者均接受腹腔镜下一期切除、吻合手术；（3）11例患者均未出现吻合口漏、切口感染、腹腔内感染等手术并发症；（4）平均随访15．2个月：局部复发率为9％（1／11），切口或穿刺孔种植率为0（0／11），无瘤生存率为91％（10／11）。结论结肠镜辅助术前减压，联合腹腔镜一期切除吻合治疗左半结肠癌肠梗阻安全有效，此法可能成为治疗左半结肠癌的最合理的治疗策略。

Objective To evaluate the effect of via-anal preoperative depression with assistance of colonoscopy and primary stage laparoscopic cancer resection and anastomosis for the treatment of malignant obstruction of left-sided colon. Methods Eleven cases of malignant left-sided colonic obstruction were treated from December 2004 to August 2007 by this modaIity. With the help of colonoscopy and the guiding of radiography, ileus tube was inserted into the proximal bowel of the obstructive site via anus. We used the tubes to decompress the dilated bowel. Patient＇s symptom, bowel sounds, abdominal girth, intra-abdominal pressure, plain abdominal radiograph were observed. After the relief of bowel obstruction, elective laparoscopic colorectal resection and anastomosis was accomplished in one stage with routine preoperative preparation. Results After 5 - 14 days of depression by ileus tube, the relief of bowel obstruction was achieved in all these patients hence emergency operation was avoided. Elective first-staged laparoscopic resection and anastomosis was performed in all 11 cases. The complications such as anastomotic leakage and incisional/abdominal cavity infection were not observed. After an average 15.2-month follow up, local recurrence rate, incisional or port implantation rate, and tumor-free survival rate were 9%,0 and 91% respectively. Conclusions First-staged laparoscopic resection and anastomosis assisted by preoperative colonoscopic depression in malignant left-sided colonic obstruction is a safe and effective procedure.