结肠内支架置入联合腹腔镜手术治疗急性左半结肠恶性梗阻的临床研究

Clinical research on colonic stent insertion combined with laparoscopic operation in the treatment for acute left colonic obstruction

目的探讨结肠内支架置入联合腹腔镜手术治疗急性左半结肠恶性梗阻的临床效果。方法选取首都医科大学潞河教学医院和第二炮兵总医院2009年7月～2012年7月收治的急性左半结肠恶性梗阻患者72例。根据手术方法将患者分为两组,采用传统开腹手术治疗患者36例为对照组,采用结肠内支架置入联合腹腔镜手术治疗患者36例为观察组,比较两组患者的临床指标。结果观察组手术时间(152.4±20.3)min、术中出血量(121.7±26.9)mL、术后肛门排气时间(2.9±0.8)d、术后住院时间(6.7±1.8)d、并发症发生率(2.8%)均明显小于对照组的(179.6±25.1)min、(162.8±37.5)mL、(3.7±1.3)d、(9.3±2.4)d、19.4%,观察组淋巴结清扫数目(15.7±2.9)枚、患者满意度(97.2%)均明显高于对照组的(12.6±3.1)枚、83.3%,差异均有统计学意义(均P<0.05)。结论结肠内支架置入联合腹腔镜手术治疗急性左半结肠恶性梗阻具有创伤小、术后恢复快、并发症发生率低等优点,是一种安全有效的治疗手段,值得临床推广使用。

Objective To investigate the clinical effect on colonic stent insertion combined with laparoscopic operation in the treatment for acute left colonic obstruction. Methods 72 patients with acute left colonic obstruction were select- ed in Luhe Teaching Hospital of Capital Medical University and the Second Artillery General Hospital of Chinese Peo- ple＇s Liberation Army from July 2009 to July 2012. According to the surgery methods, patients were divided into two groups, 36 patients used traditional open operation in the treatment were served as the control group, 36 patients used colonic stent insertion combined with laparoscopic operation in the treatment were served as the observation group. Clinical indicators were compared between two groups. Results Operation time （152.4±20.3） min, bleeding volume in operation （121.7±26.9） mL, postoperative anal exhaust time （2.9±0.8） dl postoperative hospitalization time （6.7±1.8） d, complication rate （2.8%） in observation group were significantly less than those in control group [（179.6±25.1） min, （162.8±37.5） mL, （3.7±1.3） d, （9.3±2.4） d, （19.4%）]; number of lymph node dissection （15.7±2.9）, patient satisfaction （97.2%） in the observation group were significantly higher than those in control group [（12.6±3.1）, （83.3%）], the differ- ences were all statistically significant （all P 〈 0.05）. Conclusion Colonic stent insertion combined with laparoscopic operation in the treatment for acute left colonic obstruction has less trauma, rapid recovery after operation, low compli- cation rate, which is a safe and effective treatment method and worthy of clinical use.