腹腔镜结肠切除术在轻症结直肠穿孔诊治中的应用

Application of laparoscopic colectomy in mild colorectal perforation

目的探讨轻症结直肠穿孔患者行腹腔镜病变肠段切除治疗的可行性。方法回顾性研究我院2006年6月至2016年6月间收治的61例病变肠段切除治疗的轻症结直肠穿孔患者的临床资料,对开腹手术组与腹腔镜手术组患者的术中及术后临床指标进行比较分析。结果腹腔镜手术组相较开腹手术组,术中失血量相对较少[(100±165)m L vs.(200±205)m L,P=0.032],术后住院时间短[(7±5.21)d vs.(10±9.2)d,P=0.009],但手术时间偏长[(213.7±65.7)min vs.(173.5±47.2)min,P=0.047];开腹组与腹腔镜组在术中输血量[(0.8±1.1)U vs.(0.4±0.7)U,P=0.270]、术后ICU监护时间[(2±0.9)d vs.(2±0.7)d,P=0.009]、术后并发症(25/38 vs.14/23,P=0.70)、住院费用[(31 758±29 283)元vs.(36243±27 584)元,P=0.673]均未有明显差异。结论轻症结直肠穿孔患者选择性的采用腹腔镜肠切除是安全可行的。

Objective To explore the feasibility of removal of affected segments via laparoscopic surgeryin patients with mild colorectal perforation. Methods The clinical data on sixty-one patients with colorectal perfo-ration who had been treated in our hospital between June 2006 and June 2016 were retrospectively analyzed. Thepatients were divided into an open surgery group（group OS,n = 38）and a laparoscopic surgery group（group LS,n = 23）. All the procedure-related data were collected and analyzed. P〈0.05 was considered statistically signifi-cant in this study. Results The volume of blood loss was smaller in group LS than in group OS[（100 ± 165）mLvs（200 ± 205）mL,P = 0.032],hospital stay was shorter in group LS than in group OS[（7 ± 5.21）d vs.（10 ±9.2）d,P = 0.009],and rate of wound infection was lower in group LS than in group OS（4/23 vs. 13/38,P =0.039）,while surgical duration was longer（213.7 ± 65.7 min vs. 173.5 ± 47.2 min,P = 0.047）. There were nosignificant differences between the two groups in intraoperative blood transfusion[（0.8 ± 1.1）U vs.（0.4 ± 0.7）U,P = 0.270],postoperative ICU stay[（2 ± 0.9）d vs.（2 ± 0.7）d,P = 0.009],rate of postoperative complications25/38 vs. 14/23）,and hospitalization costs[（31 758 ± 29 283）yuan vs.（36 243 ± 27 584）yuan,P = 0.673].Conclusions Laparoscopic colectomy is safe and feasible in the treatment of mild colorectal perforation.