腹腔镜治疗结直肠癌并完全梗阻的临床价值分析

Analysis of the clinical value of laparoscopic surgery in the treatment of colorectal cancer with complete obstruction

目的探讨腹腔镜手术治疗结直肠癌并完全梗阻的安全性和可行性。方法回顾性倾向性评分匹配分析2016年11月至2019年9月广东省中医院胃肠外科确诊为结直肠恶性肿瘤并完全性梗阻的72例患者临床病理资料,腹腔镜组36例,开腹组36例。结果两组患者手术时间、清扫淋巴结数量、术中出血量、切缘距肿物最近距离和术后进食时间均无统计学差异。腹腔镜组术后排气时间(2.66±1.26)d、术后住院时间(7.86±2.82)d均比开腹组短(P<0.05)。腹腔镜组和开腹组造口率分别为16.7%(6/36)和36.1%(13/36),差异有统计学意义(P=0.014)。术后并发症发病率腹腔镜组11.1%(4/36),开腹组33.3%(12/36),差异有统计学意义(P=0.042)。平均随访时间24个月,腹腔镜组预后较好(P=0.014)。结论急诊腹腔镜手术治疗结直肠恶性梗阻是安全可行的,降低术后并发症发生率,缩短术后住院时间。

Objective To study the safety and feasibility of laparoscopic surgery on colorectal carcinoma with acute obstruction.Method Retrospectively analyzed the clinical data of 72 patients with colorectal Malignant obstruction,assign to laparoscopic group and open group at the ration of 1:1.Patients’ first visit to the department of Gastrointestinal Surgery,Second Hospital Affiliated to Guangzhou University of Chinese Medicine were November 2016 to September 2019.Result There were no statistically significant differences between the two groups in operation time,number of lymph nodes dissected,intraoperative blood loss,nearest distance from the resection margin to the tumor,and postoperative feeding time.The postoperative exhaust time(2.66±1.26) d and postoperative hospitalization time(7.86±2.82) d in the laparoscopie group were shorter than those in the open group(P<0.05).The ostomy rates in the laparoscopic group and the open group were 16.7%(6/36) and 36.1%(13/36) respectively,P=0.014,the difference was statistically significant.The incidence of postoperative complications was 11.1%(4/36)in the laparoscopic group and 33%(12/36) in the open group,P=0.042,the difference was statistically significant.The mean follow-up time was 24 months,the prognosis was better in the laparoscopic group.Conclusion Emergency laparoscopic surgery for colorectal malignant obstruction is safe and feasible,reducing the complications and shortening the hospital stay after operation.