超细内镜联合腹腔镜在急性左半结肠恶性梗阻中的应用

目的:评价超细内镜联合腹腔镜在急性左半结肠恶性梗阻应用中的安全性和有效性。方法:回顾性分析2013年1—9月收治的11例急性左半结肠恶性梗阻患者临床资料。先通过超细内镜引导下置入肠道支架,解除梗阻,再行腹腔镜结直肠癌根治一期吻合术。结果:11例患者均成功置入结肠支架,病变部位包括结肠脾区1例、降结肠2例、乙降结肠交界4例、乙状结肠2例、直乙状结肠交界2例。9例患者在支架置入后接受了根治性手术,2例因肝转移实施姑息性手术。术后1例切口感染,1例肺部感染,1例吻合口出血,均经保守治疗后好转。结论:术前肠道支架减压联合腹腔镜一期吻合手术是治疗急性左半结肠恶性梗阻安全有效的方法。

Combined therapy of intestinal stent insertion under superfine endoscopy and Laperoscopy surgery for the management of acute left-sided malignant colorectal obstruction

Objective： To evaluate the safety and efficacy of self-expanding metallic stents （SEMS）in one-stage surgery for patients with acute left-sided malignant cotorectal obstructiono Methods： The clinical data of 11 patients with acute left-sided malignant colorectal obstruction who had been admitted to gastrointestinal surgery of Subei people＇s hospital from January to September 2013 were retrospectively analyzed. Preoperative intestinal stent placement under superfine endoscopy guidance was performed to remove the intestinal obstruction, then one-stage resection and anastomosis of the colorectal cancer through laparoscopic was carried out. Results： The success rate of stenting was 100%.The tumors were located in colon splenic area in one patient,in descending colon in two patients, in sigmoid-descending colon junction in four patients, in sigmoid colon in two patients and in rectum-sigmoid colon junction in two patients. Nine patients underwent laparoscopic radical surgery after stenting,two patients underwent palliative surgery. Incidence of postoperative complications was including one case of infection of the incision,one case of infection of the lung,and one case of anastomotic bleeding,which were all cured with conservative treatments. Conclusion： Preoperative intestinal stent decompression combined with primary stage laparoscopic surgery is a safe and effective method for treating acute left-sided obstructive colorectal cancer.