| 摘要: |
| ［摘要］ 目的 比较小肠减压管胃肠减压后施行腹腔镜手术与急诊开腹手术治疗右半结肠癌并梗阻的疗效。方法 收集2012-12～2018-12于广西壮族自治区人民医院普外科因右半结肠癌并梗阻行手术治疗的76例患者，将其分为小肠减压管手术组30例，术前经小肠减压管减压后限期施行腹腔镜右半结肠癌根治术；急诊手术组46例，入院后急诊行开腹右半结肠癌根治术。比较两组患者的术前血清白蛋白水平、术前电解质情况、平均手术时间、术中出血量、淋巴结清扫数量、术后3 d平均引流量、术后肛门排气时间、术后并发症情况、住院总天数及住院总费用。结果 小肠减压管手术组与急诊手术组比较，术前低蛋白血症及电解质紊乱情况改善得更好，手术时间明显缩短［(183.3±21.1)min vs (222.7±25.7)min，P<0.01］，术中出血量减少［（105.5±34.3）ml vs (226.2±64.7)ml，P<0.01］，淋巴结清扫数量增加［(21.9±3.8)枚 vs (20.1±2.9)枚，P<0.05］，术后3 d平均引流量较少［(112.3±44.6)ml/d vs (170.5±46.0)ml/d，P<0.01］，术后肛门排气时间缩短［(2.4±1.0)d vs (4.2±0.9)d，P<0.01］，住院总天数、住院总费用两组比较差异无统计学意义（P>0.05）。结论 对于右半结肠癌并梗阻的患者，术前应用小肠减压管进行胃肠减压，有助于减轻患者术前腹胀症状，为纠正患者术前的机体失衡状态争取时间，并且能为腹腔镜微创手术创造条件，腹腔镜手术时间更短、术中出血量更少、清扫淋巴结数量更多、术后恢复更快，并未增加住院时间及费用。 |
| 关键词: 小肠减压管 右半结肠癌 肠梗阻 围手术期 |
| DOI：10.3969/j.issn.1674-3806.2019.10.19 |
| 分类号:R 616.1 |
| 基金项目: |
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| Comparison of minimally invasive small intestinal decompression tube laparoscopic surgery and emergency laparotomy in treatment of right-sided colon cancer with obstruction |
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LIU Chao, FENG Ze-rong
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Department of General and Pediatric Surgery, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To observe the comparative effects between laparoscopic surgery after intestinal decompression using small intestinal decompression tube and emergency laparotomy in patients with right-sided colon cancer and obstruction during perioperative period. Methods Seventy-six patients with obstructive right-sided colon cancer receiving surgical treatment between December 2012 and December 2018 in the Department of General Surgery of the People′s Hospital of Guangxi Zhuang Autonomous Region were included in this study. The patients were divided into the intestinal decompression tube surgery group(n=30) receiving laparoscopic radical resection of right-sided colon cancer after preoperative decompression by intestinal decompression tube and the control group receiving emergency laparotomy(n=46). The preoperative serum albumin levels, preoperative electrolyte status, average operation time, blood loss, number of lymph node dissection, average drainage 3 days after surgery, postoperative anal exhaust time, postoperative complications, total length of hospital stay and total hospital costs were compared between the two groups. Results Preoperative hypoproteinemia and electrolyte disturbance in the intestinal decompression tube surgery group improved better than those in the control group. The average operation time in the intestinal decompression tube surgery group was significantly shorter than that in the control group［(183.3±21.1)minutes vs (222.7±25.7)minutes, P<0.01］. The blood loss in the intestinal decompression tube surgery group was significantly less than that in the control group ［(105.5±34.3)ml vs (226.2±64.7)ml, P<0.01］. The number of lymph nodes dissected in the intestinal decompression tube surgery group was significantly increased compared with those dissected in the control group［(21.9±3.8)nodes vs (20.1±2.9)nodes, P<0.05］. The average drainage volume in the intestinal decompression tube surgery group 3 days after surgery was significantly less than that in the control group［(112.3±44.6)ml/d vs (170.5±46.0)ml/d, P<0.01］. The postoperative anal exhaust time in the intestinal decompression tube surgery group was significantly shorter than that in the control group［(2.4±1.0)d vs (4.2±0.9)d, P<0.01］. There were no significant differences in the total length of hospital stay and the total hospital costs between the two groups(P>0.05). Conclusion For the patients with right-sided colon cancer and obstruction, preoperative gastrointestinal decompression by intestinal decompression tube is helpful to reduce the symptoms of preoperative abdominal distension and gains time to correct the preoperative imbalance of the patients and time for creating conditions for laparoscopic minimally invasive surgery. Laparoscopic surgery has shorter operation time, less intraoperative bleeding, more lymph nodes dissected, faster postoperative recovery, but does not increase the length of hospital stay and the hospital costs. |
| Key words: Small intestinal decompression tube Right-sided colon cancer Intestinal obstruction Perioperative period |
