早期外科手术干预对腹腔镜胃癌根治术后胃肠道瘘患者预后的影响

Early surgical intervention on prognosis of patients with gastrointestinal fistula after laparoscopic radical resection of gastric cancer

目的探讨早期外科手术干预对腹腔镜胃癌根治术后胃肠道瘘患者预后的影响。方法回顾性分析1 031例腹腔镜胃癌根治术患者中发生胃肠道瘘的35例患者的临床资料。其中19例急诊全麻下行开腹置管引流的患者作为手术治疗组,16例经原腹腔引流管置入套管冲洗引流的患者作为保守治疗组,比较两组的治疗结果。结果手术治疗组治愈率为94.7%,保守治疗组治愈率为81.3%,差异无统计学意义(P>0.05)。手术治疗组瘘口愈合时间为(24.58±2.52)天,保守治疗组为(26.44±2.19)天,差异有统计学意义(P<0.05)。手术治疗组平均住院时间为(42.95±2.61)天,保守治疗组为(45.56±3.20)天,差异有统计学意义(P<0.05)。手术治疗组平均住院费用为(9.63±1.61)万元,保守治疗组为(11.13±1.20)万元,差异有统计学意义(P<0.05)。结论早期外科手术干预相对于传统保守治疗可缩短腹腔镜胃癌根治术后胃肠道瘘患者瘘口愈合时间及住院时间,减少住院费用,改善预后。

Objective To investigate the effect of early surgical intervention on the prognosis of patients with gastrointestinal fistula after laparoscopic radical resection of gastric cancer. Methods Among 1 031 gastric cancer patients receiving laparoscopic radical resection,35 had gastrointestinal fistula after surgery. Clinical data of these patients were analyzed retrospectively. Laparotomic drainage placement was performed under emergency anesthesia in 19 patients（ surgical group）,while in 16 cases original drainage tube was used for abdominal drainage（ conservative group）. The results were compared between two groups. Results The cure rates of surgical and conservative groups were 94. 7% and81. 3%,respectively（ P 0. 05）. The fistula healing time of surgical and conservative groups was（ 24. 58 ± 2. 52） d and（ 26. 44 ± 2. 19） d,respectively（ P 0. 05）. The average length of hospital stay of two groups was（ 42. 95 ± 2. 61） d and（ 45. 56 ± 3. 20） d,respectively（ P 0. 05）. The average hospitalization expenses of two groups were [（ 96 300 ± 16 100）Yuan vs（ 111 300 ± 12 000） Yuan,P 0. 05]. Conclusion Early surgical intervention can significantly shorten fistula healing time and length of hospital stay,and also reduce the medical cost for patients with gastrointestinal fistula after laparoscopic radical resection.