小肠减压管胃肠减压后施行腹腔镜手术与急诊开腹手术治疗右半结肠癌并梗阻的疗效

Comparison of laparoscopic surgery and emergency open surgery for right colon cancer with obstruction after gastrointestinal decompression with small intestine decompression tube

目的探析小肠减压管胃肠减压后施行腹腔镜手术和急诊开腹手术治疗右半结肠癌合并梗阻的临床价值。方法选取2018年6月至2019年11月本院收治的右半结肠癌合并梗阻采取手术治疗患者82例作为研究对象,按随机数字法分为对照组与观察组,各41例。两组患者均采取小肠减压管胃肠减压,减压后腹胀仍显著采取急诊开腹手术治疗的作为对照组,采取择期腹腔镜手术治疗的作为观察组,比较两组患者手术相关指标、炎性因子指标水平。结果观察组患者手术时间、术后3 d平均引流量、术中出血量、肛门首次排气时间、住院时间均显著优于对照组,差异有统计学意义(P<0.05)。术前,两组患者IL-2、IL-6、TNF-α水平比较差异无统计学意义;术后,观察组患者IL-2、IL-6、TNF-α水平显著低于对照组,差异有统计学意义(P<0.05)。结论右半结肠癌合并梗阻者采取小肠减压管胃肠减压后给予腹腔镜手术治疗,可有效改善炎性因子水平,并可及时缓解患者术前腹胀的情况,缩短手术时间,降低术中出血量,减少术后引流量,促使患者及早恢复胃肠道功能。

Objective To explore the clinical of laparoscopic surgery and emergency laparotomy in the treatment of right colon cancer with obstruction after intestinal decompression tube gastrointestinal decompression.Methods From June 2018 to November 2019,82 patients with right colon cancer and obstruction who were treated in our hospital were divided into control group and observation group,with 41 cases in each group.The patients in both groups were treated with intestinal decompression tube gastrointestinal decompression,and those with significant abdominal distention after decompression were treated with emergency laparotomy as the control group,those who were treated with selective laparoscopic surgery were as the observation group,and the indexes related to operation and inflammatory factors were compared between the two groups.Results In the observation group,the operation time,3-D average flow volume,intraoperative bleeding volume,the time of first anal exhaust and hospitalization were significantly better than those in the control group(P<0.05).Before operation,there was no significant difference in the levels of IL-2,IL-6 and TNF-αbetween the two groups;after operation,the levels of IL-2,IL-6 and TNF-αin the observation group were significantly lower than those in the control group,the difference between the two groups was significant(P<0.05).Conclusion Laparoscopic operation after intestinal decompression tube gastrointestinal decompression can effectively improve the level of inflammatory factors,relieve the abdominal distention before operation,shorten the operation time,reduce the amount of intraoperative bleeding,reduce the postoperative drainage,and recover the gastrointestinal function as soon as possible.