镍钛记忆合金支架与腹腔镜手术联合治疗结直肠癌伴肠梗阻34例分析

Combined therapy of colonic stent insertion and laparoscopic surgery for the management of intestinal obstruction caused by colorectal cancer

目的探讨结直肠癌伴肠梗阻微创治疗新方法。方法对结直肠癌伴肠梗阻34例患者,先在结肠镜引导下置入记忆合金肠道支架解除梗阻,再经充分肠道准备后,腹腔镜下施行根治性切除手术。结果 34例患者手术时间160～340min,平均210min;术后胃肠功能恢复时间2～4d,平均2.1d。术后出现吻合口漏1例,切口感染2例,经保守治疗治愈。TNMⅡ期患者5例,术后住院7～12d,平均8.2d;Ⅲ～Ⅳ期患者29例,术后5-FU/LV或FOLFOX4方案化疗。随访26例,时间3～36个月,平均15个月,1例死于广泛转移,其他25例无局部复发、切口肿瘤种植及吻合口狭窄。结论记忆合金支架与腹腔镜手术联合治疗结直肠癌伴肠梗阻具有微创、安全、恢复快、疗效好等优点,值得临床推广应用。

Objective To investigate new minimal invasive surgery for intestinal obstruction caused by colorectal cancer. Methods Thirty-four patients with malignant colorectal obstruction underwent colonic stent insertion guided by an enteroscope under X-ray. Laparoscopic surgical resection was performed after clinical decompression and preoperative bowel preparation. Results The operative time was 160 - 340 mi- nutes （average 210 minutes）. The time to recovery of bowel function was 2 -4 days （average 2.1 days）. One patient experienced anastomotic leakage and 2 patients experienced incisional infection, who was recov- ered after conservative treatment. Hospital stay in 5 patients with TNM stage II was 7 - 12 days （ average 8. 2 days）. 5-FU/LV or FOLFOX4 chemotherapy was administered for 29 patients with TNM stage Ill-IV. One of 26 patients who had been followed up for 3 -36 months（ average 15 months）died of distant metastasis. There was no tumor planting in the trocar ports or the incision. None of the patients had local recurrence after operation as well as anastomotic stricture. Conclusion Combined therapy of stent insertien and laparoscopic surgery for malignant colorectal blockage is effective and safe.