支架置入术后择期腹腔镜治疗结直肠癌并肠梗阻的时机选择

Determination of time for laparoscopic treatment of colorectal cancer with intestinal obstruction after stent implantation

探讨结肠镜下支架植入术后择期腹腔镜治疗结直肠癌合并肠梗阻的疗效及择期腹腔镜手术的时机。86例结直肠癌并肠梗阻患者作为观察对象，事先经肠镜下支架置入术解除梗阻，待患者胃肠道功能恢复、肠道清洁良好、水电解质紊乱纠正、患者一般情况良好、可耐受手术后，再行腹腔镜手术。根据支架置入后不同时期再行腹腔镜治疗的时间，将患者分为观察Ⅰ组（3~6 d）、Ⅱ组（7~9 d）、Ⅲ组（10~14 d）和Ⅳ组（〉14 d），比较各组手术情况及术后并发症、术后肛门排气时间及住院时间。所有患者均经腹腔镜下成功切除病灶并行淋巴结清扫，无中转开腹手术患者，围手术期无死亡病例。4组间手术时间、术中出血量、淋巴结清扫数目、术后肛门排气情况、术后住院时间及术后并发症均无显著差异（P〈0.05）。结直肠癌合并肠梗阻患者，在肠镜下支架置入术后择期行腹腔镜根治术安全、有效、可行。支架置入后择期腹腔镜手术的时机，应根据患者肠道功能及一般状态恢复情况而定，在支架置入后3~16 d行腹腔镜根治术是安全可行的。

To explore the suitable time for the treatment of colorectal cancer with intestinal obstruction under colonoscopy after stent implantation. Total 86 patients with colorectal cancer and intestinal obstruction were selected as observation subjects, who were firstly provided with stent implantation under colonoscopy to remove intestinal obstruction. After the gastrointestinal function of the patients recovered and the intestinal tract was cleaned well as well as the disorders of water and electrolyte were corrected and the patients were in good condition generally and could receive the operation, laparoscopic operations were performed on them. According to the difference in time for laparoscopic treatment after stent implantation, the patients were divided into observation groupⅠ（3-6 days）, observation groupII（7-9 days）, observation groupⅢ （10-14 days）, and observation groupⅣ （〉 14 days）; and then, the intraoperative and postoperative complications, postoperative anal exhaust time and hospitalization period were compared and analyzed among four groups. All focuses were successfully removed by laparoscopic resection and lymph node dissection was carried out; there was no intraoperative conversion to abdominal operation or death in the perioperative period. In the four groups, the operation time, bleeding volume, number of lymph node dissection, postoperative anal exhaust time, postoperative hospitalization period and postoperative complications had no significant difference （P〉 0.05）. Selective treatment of colorectal cancer with intestinal obstruction after stent implantation under colonoscopy is safe, effective, and feasible. The time for selective laparoscopy after stent implantation shall depend on the intestinal function and recovery conditions of the patients. It is safe and feasible for laparoscopic resection to be carried out within 3-16 days after the stent implantation.