肠减压后腹腔镜辅助右半结肠切除术在右半结肠癌伴肠梗阻中的应用

Application of laparoscopically assisted right hemicolectomy after intestinal decompression for right hemicolon carcinoma complicating intestinal obstruction

目的探讨肠减压后腹腔镜手术与传统开腹手术在右半结肠癌并急性肠梗阻中的可行性与疗效。方法回顾性分析2019年1月至2020年6月在该院普通外科就诊的53例急性右侧梗阻性结肠癌患者的病历资料。入选患者术前腹部立位平片及腹部CT均明确提示为右半结肠癌伴肠梗阻,不减压均无法建立腹腔镜操作空间,术后病理证实为结肠癌。根据其手术方式分为肠减压后联合入路翻页式腹腔镜辅助右半结肠癌根治术组(腹腔镜组,n=22)和传统开腹手术组(传统开腹组,n=31)。比较两组患者的一般资料、手术时间、出血量、切口长度、肛门排气时间、术后住院时间及术后并发症的差异。结果两组患者基线资料比较差异无统计学意义(P>0.05)。腹腔镜组、传统开腹组患者术中出血量分别为(24.48±7.57)、(69.00±12.87)mL,切口长度分别为(6.80±0.56)、(18.55±1.32)cm,肛门排气时间分别为(40.85±3.60)、(68.43±3.04)h,术后住院时间分别为(6.41±1.74)、(11.71±1.40)d,两组患者上述指标比较差异均有统计学意义(P<0.05)。腹腔镜组、传统开腹组患者手术时间分别为(171.47±9.01)、(185.18±9.40)min,两组患者手术时间及术后并发症(手术切口感染率、吻合口瘘、腹腔内出血、腹腔感染)比较,差异均无统计学意义(P>0.05)。结论对右半结肠癌并急性肠梗阻患者采用肠减压后联合入路翻页式腹腔镜辅助右半结肠癌根治术具有创伤小、安全、有效等优势。

Objective To investigate the feasibility and efficacy of laparoscopic surgery and traditional open surgery in the treatment of right hemicolon cancer complicating acute intestinal obstruction.Methods The medical records of 53 patients with acute right obstructive colon cancer admitted to the general surgery department of the hospital from January 2019 to June 2020 were retrospectively analyzed.The selected patients were diagnosed as right hemicolon cancer complicating intestinal obstruction by abdominal X-ray and abdominal CT before operation.No laparoscopic operation space could be established without decompression.Postoperative pathology confirmed that all patients were diagnosed as colon cancer.According to the operation methods,they were divided into the two groups:the intestinal decompression combined with approach turn-over laparoscopic assisted right hemicolon cancer radical operation group(laparoscopic group,n=22)and traditional laparotomy group(n=31).The differences in the general data,operation time,blood loss volume,incision length,time of anal exhausting,postoperative hospital stay and postoperative complications were compared between the two groups.Results The baseline data had no statistical difference between the two groups(P>0.05).The bleeding amount in the laparoscopic group and traditional laparotomy group was(24.48±7.57)mL and(69.00±12.87)mL respectively,the incision length was(6.80±0.56)cm and(18.55±1.32)cm,the time of anal exhausting was(40.85±3.60)h and(68.43±3.04)h,postoperative hospital stay was(6.41±1.74)d and(11.71±1.40)d,and the differences were statistically significant(P<0.05).The operation time in the laparoscopic group and traditional laparotomy group was(171.47±9.01)min and(185.18±9.40)min respectively,and the operation time and postoperative complications(incision infection rate,anastomotic leakage,intraperitoneal hemorrhage,abdominal infection)had no statistically significant differences between the two groups(P>0.05).Conclusion For the patients with right hemicolon cancer complicating acute intestinal obstruction,adopting combined approach turn-over laparoscopic assisted right hemicolon cancer radical operation after intestinal decompression has the advantages of small trauma,safety and effectiveness.