结直肠梗阻支架植入后腹腔镜手术的临床疗效

目的探讨结直肠肿瘤致结肠梗阻支架植入治疗后再行腹腔镜结直肠癌根治术的可行性。方法回顾性分析2009年10月至2011年11月上海市第十人民医院收治的行支架植入治疗的21例结直肠肿瘤致急性梗阻患者的临床资料。对支架植入情况、肠梗阻症状、相关疾病缓解情况、腹腔镜手术结果等进行分析，计数资料采用Fisher确切概率法检验。结果21例左半结肠梗阻患者中17例支架植入成功；支架植入后肠梗阻症状均在24h内得到缓解。支架植入后患者Alb、Hb获得明显改善，酸碱失衡、水电解质紊乱获得纠正，高血压、糖尿病、心肌缺血、肺部感染均有明显改善，麻醉风险明显降低（P〈0．05）。心律失常、慢性阻塞性肺病等内科疾病则改善不明显（P〉0．05）。4例支架植入治疗失败患者，1例支架导致结肠穿孔，3例因完全梗阻未能植入，均行急诊Ha~mann手术。所有肠梗阻症状缓解患者顺利行腹腔镜结直肠癌根治术。腹腔镜手术时间为（142±38）min，出血量为（29±11）mL，远切缘距肿瘤距离为（3．8±0．3）em，左髂区斜切口长度为（6．2±2．8）cm。术后无吻合口瘘发生，排气时间为（2．4±0．6）d，进食时间为（3．8±1．6）d，术后住院时间为（17±4）d。21例患者随访6个月至2年，1例术后1年因脑血管意外死亡；2例发生肿瘤肝转移，目前仍在维持化疗中。其余18例患者均无瘤生存。结论肿瘤导致的结直肠梗阻经支架植入治疗使肠梗阻缓解后再行腹腔镜结直肠癌根治术是可行的。

Feasibility of a single-stage operation consisting of self-ex- pandable metallic stent implantation followed by laparoscopicsurgery for obstructive left colon obstruction

Objective To investigate the feasibility of a single-stage operation consisting of self-expandable metallic stent （SEMS） implantation followed by laparoscopic surgery for color- ectal obstruction. Methods The clinical data of 21 patientswith colorectal obstruction who received SEMS implantation at the Shanghai Tenth People＇s Hospital from October 2009 to November 2011 were retrospectively analyzed. The SEMS place- ment, colorectal obstruction, disease remission rate and the outcome of laparoscopic surgery were analyzed. All data were analyzed using the Fisher exact probability. Results SEMS was successfully implanted in 17 patients, and colorectal obstruction was alleviated within 24 hours. The levels of albumin and hemo- globin were back to normal, and acid-base disturbance, water electrolyte disorder were rectified. The symptoms of hyperten- sion, diabetes, myocardial ischemia and pulmonary infection were alleviated, and the anesthesia risk was significantly reduced （P 〈 0.05 ）. There were no significant difference in the allevia- tion of arrhythmia and chronic obstructive pulmonary disease （ P 〉 0.05 ）. Of the 4 patients who were failed in SEMS implantation, 1 patient had colonic perforation caused by stents, and the other 3 patients had complete colorectal obstruction, and they were converted to Hartmann procedure. Laparoscopic colorectai resec- tion was completed successfully in the 17 patients who had remis- sion of colorectal obstruction. The operation time, volume of blood lose, distance from distal resection margin to tumor, length of incision were （ 142 _＋ 38 ） minutes, （29 _＋ 11 ） mL, （3.8 ＋ 0.3 ） cm and （6.2 ＋ 2.8） cm, respectively. No anastomotic fistula occurred. The time to anal exhaust time, time to food intake and post- operative hospital stay were （2.4 ＋ 0.6） days, （3.8 ＋ 1.6） days, （ 17 ＋ 4） days, respectively. The 21 patients were followed up for 6 months to 2 years, 1 patient died of cerebral vascular bleeding; 2 patients had hepatic metastasis and they received chemotherapy; 18 patients were sound and well. Conclusion A single-stage operation consisting of SEMS placement followed by laparoscopic surgery is a feasible and safe treatment option for patients with colorectal obstruction.