支架与肠梗阻导管在腹腔镜手术治疗梗阻性结直肠癌中的应用

The application of stent and transanal ileus tube in laparoscopic treatment of obstructive colorectal cancer

目的：探讨梗阻性结直肠癌患者内镜下肠道支架或经肛肠梗阻导管置入术后行腹腔镜辅助肿瘤切除、肠管一期吻合的安全性与可行性,对比肠道支架及经肛肠梗阻导管两种肠道准备方法的临床效果。方法：回顾分析2009年7月至2014年6月因梗阻性结直肠癌在结肠镜引导下行经肛肠梗阻导管（导管组）或肠道支架（支架组）置入术后行腹腔镜辅助结直肠癌根治、肠管一期吻合术51例患者的临床资料。比较两组患者手术情况、术后并发症及手术远期疗效。结果：支架组支架置入术后肠道准备时间平均（4.2±1.1）d,导管组平均（6.9±1.6）d,两组差异有统计学意义（P=0.03）。两组中转开腹率（P=1.00）、造瘘率（P=0.12）、手术时间（P=0.14）、术中出血量（P=0.49）、左髂切口长度（P=0.21）、术后切口感染（P=0.37）、吻合口漏（P=0.18）、排气时间（P=0.62）、进流食时间（P=0.33）、术后住院时间（P=0.20）差异均无统计学意义。术后随访4-47个月,平均（27.33±10.37）个月,支架组吻合口复发率为9.09%,导管组吻合口无一例复发,两组差异无统计学意义（P=1.00）。结论：梗阻性结直肠癌患者经肛肠梗阻导管或肠道支架置入术后行腹腔镜辅助肿瘤切除、一期肠道吻合术均是安全、有效、可行的。肠道支架植入术较经肛肠梗阻导管置入术在腹腔镜辅助肿瘤切除、肠道一期吻合术肠道准备方面更具优势。

Objective： To evaluate the safety and feasibility of endoscopic stenting and catheterization of transanal ileus tube in obstructive colorectal cancer followed by laparoscopic resection and one-stage anastomosis surgery,and compare the clinical efficacy of the two approaches. Methods： The clinical data of 51 patients,from Jul. 2009 to Jun. 2014,with operable obstructive colorectal cancer in the People＇s Liberation Army General Hospital were analyzed retrospectively,and they were divided into two groups： stent group and ileus tube group,then underwent colonoscopic-guided stenting or transanal ileus tube followed by laparoscopic-assisted radical resection and one-stage anastomosis surgery. The operation,complication and long-term effect were compared between them. Results： The average time of bowel preparation in stent group was（ 4. 2 ± 1. 1） d,and（ 6. 9 ± 1. 6） d needed in ileus tube group,the difference was statistically significant（ P = 0. 03）; but there was no significantly statistical difference in rate of conversion from laparoscopic surgery to open surgery（ P = 1. 00）,incidence of colostomy（ P = 0. 12）,average operation time（ P = 0. 14）,average blood loss（ P = 0. 49） and left iliac incision length（ P = 0. 21） between the two groups; Statistically significant differences did not exist in postoperative rates of infections of incision（ P = 0. 37）,anastomotic leakage（ P = 0. 18）,exhaust time（ P = 0. 62）,time for liquid diet（ P = 0. 33）,average postoperative hospital time（ P = 0. 20） between the two groups. During the follow-up of（ 27. 33 ± 10. 37） months（ range,4 to 47 months）,the local recurrence rate of stent group was 9. 09% while the ileus tube group was 0%,there was no significant statistical difference between this two groups（ P = 1. 00）. Conclusions： It is proved feasible,effective and safe of stenting and catheterization of transanal ileus tube in obstructive colorectal cancer followed by laparoscopic-assisted resection and one-stage anastomosis. When it comes to preopera-tive preparation time,stenting has an advantage over catheterization of transanal ileus tube.