腹腔镜治疗恶性肠梗阻及术前应用生长抑素的价值

Value of laparoscopy and preoperative somatostain for malignant bowel obstruction

目的探讨生长抑素联合肠外营养在恶性肠梗阻腹腔镜手术前应用的价值。方法 53例恶性肠梗阻患者作为观察组,采用生长抑素联合全胃肠外营养进行围术期处理;同期27例常规处理病例为对照组;比较两组临床症状、体征改善情况。对观察组中符合腔镜手术适应证者施行腹腔镜手术治疗,有禁忌证者采用开放手术,比较两组的治疗效果。结果观察组腹痛、腹胀缓解率及肛门恢复排气、排便率均高于对照组(P<0.05),而每日胃肠减压量、肠管直径差值均小于对照组(P<0.01)。腔镜组手术时间、出血量、肛门恢复排气时间、住院时间、并发症发生率均少于开放组(P<0.01)。结论腹腔镜治疗恶性肠梗阻具有可行性,术前使用生长抑素可提高恶性肠梗阻行腹腔镜治疗的适应证。

Objective To study the value of somatostatin and total parenteral nutrition（TPN） on the preoperative preparation of laparoscopy in malignant bowel obstruction（MBO）. Methods Fifty-three patients with MBO were treated with somatostain and TPN（observation group）, and another 27 patients received conventional therapy（control group） at the same time. The improvement of clinical symptoms and signs was compared between both groups. In observation group, the patients underwent laparoscopic or open surgery based on the indications or contraindications for laparoscopy, and their therapeutic effects were also compared. Results Compared with the control group, the rates of stomachache and abdominal distention remission, and anal exsufflation and defecation were increased（P〈0.05）, while the gastrointestinal decompression volume and intestinal diameter difference were decreased（P〈0.05） in the observation group. The operation time, blood loss, anal exsufflation time, hospital stay and complications were lower in the laparoscopic group than those in the open group（P〈0.01）. Conclusion Laparoscopic surgery is feasible for MBO. Preoperative somatostatin can improve the laparoscopic indications in patients with MBO.