腹腔镜联合结肠镜手术与开腹手术治疗特殊类型结直肠息肉的临床研究

Clinical study of laparoscopic combined with colonoscopic surgery and open surgery in the treatment of special types of colorectal polyps

目的：探讨腹腔镜联合结肠镜手术（双镜手术）与开腹手术治疗特殊类型结直肠息肉的优缺点。方法回顾性分析62例实施手术治疗的特殊类型结直肠息肉（宽基无蒂、特殊部位或怀疑癌变，内镜下切除困难或存在较大风险）患者的临床资料，其中实施双镜手术42例（双镜组），开腹手术20例（开腹组）。比较两组患者的手术时间、术中出血量、术后排气时间、术后住院时间和并发症发生率等。结果两组均无手术失败病例，均成功切除息肉病灶，无手术相关死亡病例。双镜组无中转开腹病例。开腹组2例单纯依靠手的触摸感未能确定病灶位置，遂借助术中结肠镜予以成功定位。双镜组手术时间、术中出血量、术后排气时间、术后住院时间和并发症发生率均明显小于开腹组[（60.5±25.4）min比（75.8±20.6）min、（30.5±15.8）ml比（55.2±24.6）ml、（24.6±10.5）h比（40.5±16.8）h、（3.2±1.0）d比（5.8±2.2）d、0比20%（4/20）]，差异有统计学意义（P＜0.05）。其中开腹组术后早期炎性肠梗阻1例、腹腔感染1例、切口感染2例，经保守治疗痊愈。随访3～36（18.6±12.3）个月，所有患者均存活，两组均未发生复发和转移，无吻合口狭窄和吻合口瘘等并发症。结论对于特殊类型的结直肠息肉，双镜手术较开腹手术创伤小、恢复快、并发症少，是内镜下切除之外的首选治疗方式。

Objective To explore the advantages and disadvantages of laparoscopic combined with colonoscopic surgery （double endoscope surgery） and open surgery in the treatment of special types of colorectal polyps. Methods The clinical data of 62 patients with special types of colorectal polyps （wide base sessile, special parts or suspected cancerous, endoscopic resection difficult or high risk） were retrospectively analyzed. Among them, 42 patients underwent double endoscope surgery （double endoscope group）, and 20 patients underwent open surgery （open group）. The operating time, amount of bleeding during operation, postoperative exhaust time, postoperative hospital stay and complication rate were compared between 2 groups. Results All the patients had successful resection of the polyps, and there were no operative deaths. There was no conversion to open surgery in double endoscope group. Two patients in the open group were unable to locate the lesion by the tactile sensation of the hand and then succeeded in locating by intraoperative colonoscopy. The operating time, amount of bleeding during operation, postoperative exhaust time, postoperative hospital stay and complication rate in double endoscope group were significantly lower than those in open group： （60.5 ± 25.4） min vs. （75.8 ± 20.6） min, （30.5 ± 15.8） ml vs. （55.2 ± 24.6） ml, （24.6 ± 10.5） h vs. （40.5 ± 16.8） h, （3.2 ± 1.0） d vs. （5.8 ± 2.2） d and 0 vs. 20% （4/20）, and there were statistical differences （P〈0.05）. There was 1 case with early postoperative inflammatory bowel obstruction, 1 case with abdominal infection and 2 cases with incision＆amp;nbsp;infection in open group. There was no operative death in the two groups, and these patients were cured by conservative treatment. The follow-up time was 3-36 （18.6 ± 12.3） months, and all the patients survived. The patients in 2 groups had no recurrence and metastasis, no anastomotic stenosis, anastomotic leakage and other complications. Conclusions For the special types of colorectal polyps, double endoscope surgery is less invasive, with faster recovery and less complications. It is the first choice except for endoscopic resection.