腹腔镜与结肠镜双镜联合在结直肠息肉切除术中的应用效果

A randomized controlled study to evaluate the effect of laparoscopy combined with colonoscopy in colorectal polypectomy

目的探讨腹腔镜与结肠镜双镜联合在结直肠息肉切除术中的应用效果。方法选取2009年1月至2016年11月本院收治的结直肠息肉患者38例,采用随机、单盲、平行对照法分为腹腔镜组和双镜组,每组19例;腹腔镜组行腹腔镜结直肠息肉切除术,双镜组联合腹腔镜与结肠镜进行结直肠息肉切除术,比较两组术中出血量及手术时间等指标及术后胃肠功能恢复情况,术后定期随访,观察息肉复发情况。结果两组均无手术相关死亡病例,成功切除息肉病灶,腹腔镜组有1例因息肉较小,无法明确定位,进行中转开腹治疗,双镜组无中转开腹病例。与腹腔镜组比较,双镜组患者手术时间和住院时间明显缩短,术后3 d视觉摸拟评分(VAS)降低,差异有统计学意义(P<0.05)。与腹腔镜组比较,术后双镜组肛门排气时间、腹胀持续时间、肠鸣音恢复时间及进食时间均显著缩短,差异有统计学意义(P<0.05)。两组术后均未出现腹腔出血、吻合口瘘及泌尿系统感染等严重并发症;两组随访时间5~24个月,均未出现息肉复发病例。结论腹腔镜与结肠镜双镜联合治疗结直肠息肉能够准确地定位病变,并有助于患者预后及胃肠功能的恢复,值得临床推广。

Objective To evaluate the efficacy of laparoscopic combined with colonoscopy in colorectal polypectomy.Methods 38 cases of patients with colorectal polyps enrolled in our hospital from January 2009 to November 2016 were divided into laparoscopic group（LAP-group）and double-lens group（DL group）with randomized,single-blind and parallel control. LAP-group was treated with laparoscopic colorectal polypectomy;DL group was given laparoscopic combined with colonoscopy. The intraoperative blood loss,operation time and postoperative gastrointestinal function recovery in the 2 groups were compared;postoperative follow-up was performed to observe the recurrence of polyps. Results There were no cases of surgery-related death in the 2 groups. 1 case of LAP-group due to small polyps could not be clearly positioned to carry out laparotomy. DL group had no case to transfer to carry out laparotomy. Compared with LAP-group,the operation time and hospitalization time of the patients in the DL group were significantly shortened,and visual analogue scale/score（VAS） postoperative 3 d decreased（P〈0.05）. Compared with LAP-group,the duration of anal exhaust,duration of abdominal distension,recovery time of bowel sounds and eating time were significantly shortened（P〈0.05）. No serious complications such as intraperitoneal hemorrhage,anastomotic fistula and urinary tract infection were found in the 2 groups postoperation;the 2 groups were followed up for 5-24 months,no recurrence of polyp case happened. Conclusion Laparoscopic combined with colonoscopy in the treatment of colorectal polyps can accurately locate the lesion and improve the prognosis of patients and the recovery of gastrointestinal function;it is worthy of clinical application.