CAJ | 학술논문

目的探讨左半结肠癌并肠梗阻患者腔内支架置入后再行腹腔镜手术的疗效及手术时机的选择.方法前瞻性将49例左半结肠癌并梗阻患者由计算机随机分入支架联合腹腔镜手术组(29例,其中支架后3 d手术15例、10 d后手术14例)和开腹手术组(20例),对比分析3组患者一期手术吻合成功例数、中转开腹率、手术时间、住院时间、术中失血量、疼痛评分、永久造口率和术后并发症发生情况.结果与开腹组比较,支架联合腹腔镜手术组患者一期手术吻合成功率高(62.1%比35.0%,P=0.004),永久造口率低(6.9%比35.0%,P=0.024),失血量少(15～200 ml比120～610 ml,P=0.000),疼痛轻(术后疼痛评分2.5分、3.0分比8.0分,P=0.000),相关并发症少(5例次比10例次).支架联合腹腔镜手术两组之间,与3 d后手术组比较,10 d后手术组患者一期手术吻合成功率高(85.7%比40.0%,P=0.001)中转开腹率低(14.3%比46.7%,P=0.046).结论左半结肠癌并梗阻患者放置腔内支架后的腹腔镜手术是可行的,放置支架后10 d行腹腔镜手术较为合适.
목적 탐토좌반결장암병장경조환자강내지가치입후재행복강경수술적료효급수술시궤적선택.방법 전첨성장49례좌반결장암병경조환자유계산궤수궤분입지가연합복강경수술조(29례,기중지가후3 d수술15례、10 d후수술14례)화개복수술조(20례),대비분석3조환자일기수술문합성공례수、중전개복솔、수술시간、주원시간、술중실혈량、동통평분、영구조구솔화술후병발증발생정황.결과 여개복조비교,지가연합복강경수술조환자일기수술문합성공솔고(62.1%비35.0%,P=0.004),영구조구솔저(6.9%비35.0%,P=0.024),실혈량소(15～200 ml비120～610 ml,P=0.000),동통경(술후동통평분2.5분、3.0분비8.0분,P=0.000),상관병발증소(5례차비10례차).지가연합복강경수술량조지간,여3 d후수술조비교,10 d후수술조환자일기수술문합성공솔고(85.7%비40.0%,P=0.001)중전개복솔저(14.3%비46.7%,P=0.046).결론 좌반결장암병경조환자방치강내지가후적복강경수술시가행적,방치지가후10 d행복강경수술교위합괄.
Objective To study the efficacy of stenting followed by laparoscopic surgery in the treatment of obstructing left-sided colon cancer. Methods Forty-nine patients with obstructing left-sided colon cancer were prospectively randomized into two groups. Twenty patients received emergent open surgery, while 15 underwent laparoscopic surgery 3 days after placement of the self-expanding metal stent (SEMS) and 14 of them received laparoscopic surgery 10 days after placement of SEMS. Outcomes evaluated included 1-stage operation rate, conversion rate, operative time, length of hospital stay,blood loss, postoperative pain score and use of analgesics, rates of permanent stoma, and postoperative complications. Results Compared with emergent open surgery, patients undergoing laparoscopic surgery had significantly less blood loss (P=0.000), lower permanent stoma rate (P=0.024), less pain (P=0.000), and lower incidence of postoperative complications. Laparoscopic surgery was associated with a significantly higher rate of 1-stage operation (P=0.004). Compared with patients undergoing laparoscopic surgery 3 days after SEMS placement, patients who underwent laparoscopic surgery 10days after SEMS placement had a significantly hihger 1-stage operation rate (P=0.001) and a lower conversion rate(P=0.046). Conclusions Self-expanding metal stenting is a safe and effective bridge to laparoscopic surgery in patients with obstructing left-sided colon cancer. Laparoscopic surgery 10 days after SEMS placement may be more appropriate.