肠道支架序贯腹腔镜手术在左半结肠恶性梗阻中的临床应用

An Analysis on Intestinal Stent Implantation Combined with Laparoscopic Surgery in Left-side Malignant Colonic Obstruction

目的:评估肠道支架序贯腹腔镜手术在左半结肠恶性梗阻中的临床应用疗效。方法:回顾性收集2015年1月至2022年9月我院收治的符合条件的127例左半结肠恶性梗阻患者的临床资料。根据治疗方式的不同,将患者分为序贯组(41例,先行支架置入术再行腹腔镜手术)和常规组(86例,未行支架置入术,直接手术)。比较2组患者术前检查、术中情况及术后近期疗效。结果:置入支架后Hb<90 g/L、WBC>10×10^(9)/L、Alb<35 g/L、Na^(+)<135 mmol/L、K^(+)<3.5 mmol/L、Ca^(2+)<2.1 mmol/L者比例明显低于未置入支架者,P<0.05。序贯组支架置入成功率为92.7%,并发症发生率为7.3%,穿孔率为4.9%。与常规组相比,序贯组腹腔镜手术率、一期切除吻合率更高,淋巴结清扫数更多,造口率更低,术后住院时间、引流量更少,P<0.05。2组手术时间、术中出血量、术后排气排便时间、术后并发症、标本病理特征、住院总费用方面比较差异均无统计学意义,P>0.05。结论:对于左半结肠恶性梗阻患者,肠道支架序贯腹腔镜手术安全有效,可以提高一期吻合率,降低肠造口率,增加淋巴结清扫数,缩短术后恢复时间,改善患者术后生活质量,且不增加手术并发症和住院费用。

Objective To evaluate the clinical efficacy of intestinal stent implantation combined with laparoscopic surgery in patients with left-side malignant colonic obstruction.Methods The clinical data of 127 patients with left-side malignant colonic obstruction admitted to authors'hospital from January 2015 to September 2022 were retrospectively collected.According to different treatment methods,the patients were divided into the combined operation group(41 patients,intestinal stent implantation combined with laparoscopic surgery)and conventional operation group(86 patients,non-stent implantation and direct operation).Compared the difference of preoperative data,intraoperative condition and short-term curative effect between the two groups.Results The proportion of patients with Hb90 g/L,WBC10×10^(9)/L,Alb<35 g/L,Na^(+)<135 mmol/L,K^(+)<3.5 mmol/L,Ca^(2+)<2.1 mmol/L after stent implantation was significantly lower than that of the non-stent patients(P<0.05).In the combined operation group,the success rate of stent implantation was 92.7%,the incidence of complications was 7.3%,and the incidence of perforation was 4.9%.Compared with the conventional operation group,the combined operation group had higher laparoscopic operation rate,more lymph node dissection,higher I-stage anastomosis rate,lower colostomy rate,shorter postoperative hospital stay and less drainage(P<0.05).There was no significant difference between the two groups in operating time,bleeding volume during operation,postoperative flatus and defecation time,surgical complications,pathological features of specimen,and cost for treatment(all,P>0.05).Conclusion For patients with left-side malignant intestinal obstruction,intestinal stent implantation combined with laparoscopic surgery is a safe and effective treatment method,which can improve the first-stage anastomosis rate,reduce the rate of colostomy,increase the number of lymph node clearance,shorten the postoperative recovery time and improve patients'quality of life,also,without increasing the surgical complications and hospitalization costs.