金属支架联合腹腔镜与急诊开腹手术治疗结直肠癌并急性肠梗阻近期疗效比较

目的比较金属支架联合腹腔镜与急诊开腹手术治疗结直肠癌并急性肠梗阻的近期疗效，寻求安全有效的治疗方法。 方法回顾性分析2017年1月至2019年3月120例结直肠癌并急性肠梗阻患者资料，根据手术方法分为两组，金属支架联合腹腔镜治疗的57例为联合组，63例行急诊开腹手术的患者为开腹组。应用SPSS19.0统计软件进行数据分析，围术期指标以( ±s)表示，独立t检验，并发症发生率、二期手术率等采用χ²检验，P<0.05为差异有统计学意义。 结果联合组手术时间为(179.8±17.3) min，术后排气时间为(2.3±0.5) d，术后住院时间为(7.3±1.9) d，均短于开腹组的(209.5±21.0) min、(4.6±0.8) d、(11.9±3.2) d；联合组淋巴结清扫数为(16.7±2.1)个，多于开腹组的(12.4±1.7)个，术中出血量为(27.9±4.1) ml，少于开腹组的(75.5±9.3) ml，差异均有统计学意义(P<0.05)。联合组造口4例，二期行造口关闭术4例，开腹组造口17例，二期行造口关闭术17例，联合组并发症发生率为12.3%，二期手术率为7.0%，均低于开腹组的44.4%、27.0%，差异均有统计学意义(P<0.05)。 结论金属支架联合腹腔镜治疗结直肠癌并急性肠梗阻安全、可行，且手术根治效果好，能有效降低二期手术率。

Comparison of the short-term clinical outcome of metal stent combined with laparoscopic surgery and emergency laparotomy in the treatment of colorectal cancer with the acute intestinal obstruction

ObjectiveTo compare the short-term clinical outcome of metal stent combined with laparoscopic surgery and emergency laparotomy in the treatment of colorectal cancer with the acute intestinal obstruction. MethodsFrom January 2017 to March 2019, clinical data of 120 patients with colorectal cancer and acute ileus were analyzed retrospectively. According to the operation method, 120 patients divided into combined group (57 cases) and open group (63 cases). Statistical analysis were performed by using Spss19.0 software. The perioperative indexes were expressed as ( ±s) and were examined by using independent t-test. Complication rate and secondary operation rate were analyzed by using χ² test (P<0.05). ResultsIn the combined group, the operation time was (179.8±17.3) min, the postoperative anal exhaust time was (2.3±0.5) d, the postoperative hospitalization time was (7.3±1.9) d, which were shorter than (209.5±21.0) min, (4.6±0.8) d and (11.9±3.2) d in the open group respectively. The harvested lymph nodes of (16.7±2.1) in the combined group was more than (12.4±1.7) in the open group. The amount of intraoperative hemorrhage of (27.9±4.1) ml in the combined group was less than (75.5±9.3) ml in the open group, with statistically significant difference (P<0.05). There were 4 cases of colostomy in the combined group, then received secondary closure surgery. There were 17 cases of colostomy in the open group, then received secondary closure surgery. The incidence of complications in the combined group was 12.3% and secondary closure surgery rate of 7.0%, which were lower than 44.4% and 27.0% in the open group respectively(P<0.05). ConclusionMetal stent combined with laparoscopy is safe and feasible in the treatment of colorectal cancer with acute intestinal obstruction, and the short-term effect of radical operation is good, which could effectively reduce the secondary closure surgery rate.