Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan.
Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan.
Int J Surg. 2017 Jun;42:90-94. doi: 10.1016/j.ijsu.2017.04.052. Epub 2017 Apr 27.
Several authors have reported on the utility of a laparoscopic approach for the palliation of malignant bowel obstruction (MBO); however, the advantages of laparoscopic surgery for MBO have not yet been confirmed.
We retrospectively reviewed the medical records of patients who underwent palliative surgery for MBO between 2007 and 2015. Laparoscopic procedures have been performed when technically possible since 2014. Successful palliation was defined as the ability to tolerate solid food (TSF) for at least 2 weeks.
Twenty-two patients underwent laparoscopic palliative surgery, and 171 patients underwent conventional open palliative surgery to relieve the symptoms of MBO. Laparoscopic palliative surgery was performed for patients with MBO due to colorectal cancer (n = 12), uterine cancer (n = 3), and other types of cancers (including gastric, prostate, and renal cancer). The following laparoscopic procedures were performed: stoma placement (n = 18), palliative resection (n = 3) and bypass (n = 2). The median operative time was 100 min and the median operative blood loss was 9 ml. The laparoscopic palliative operation allowed 91% (20/22) of the patients to consume a solid diet for more than 2 weeks, and be discharged from hospital. There were no significant differences between laparoscopic surgery and open surgery with regard to the ability to TSF or the postoperative mortality rate. The postoperative morbidity (Clavien-Dindo Grade ≥ II) rates in the laparoscopic and open surgery groups were 14% and 32%, respectively. Laparoscopic surgery led to a significantly lower rate of postoperative surgical site infection (SSI) in comparison to open surgery (4.5% vs 32%; P = 0.0053).
A laparoscopic approach in palliative surgery for MBO was safe and feasible, and was associated with a lower incidence of SSIs. By minimizing the postoperative morbidity rate, the laparoscopic approach may provide significant benefits to patients with MBO who have a limited life expectancy.
多位作者报告了腹腔镜在恶性肠梗阻（MBO）姑息治疗中的应用价值；然而，腹腔镜手术治疗 MBO 的优势尚未得到证实。
我们回顾性分析了 2007 年至 2015 年间接受 MBO 姑息性手术的患者的病历。自 2014 年以来，只要技术上可行，我们就会进行腹腔镜手术。成功的姑息性治疗定义为能够耐受固体食物（TSF）至少 2 周。
22 例患者接受了腹腔镜姑息性手术，171 例患者接受了常规开腹姑息性手术以缓解 MBO 症状。腹腔镜姑息性手术用于治疗结直肠癌（n=12）、子宫癌（n=3）和其他类型癌症（包括胃癌、前列腺癌和肾癌）引起的 MBO 患者。以下是进行的腹腔镜手术：造口术（n=18）、姑息性切除术（n=3）和旁路手术（n=2）。手术时间中位数为 100 分钟，术中出血量中位数为 9 毫升。腹腔镜姑息性手术使 91%（20/22）的患者能够进食固体饮食超过 2 周，并出院。在 TSF 能力或术后死亡率方面，腹腔镜手术与开腹手术之间无显著差异。腹腔镜和开腹手术组的术后并发症（Clavien-Dindo 分级≥II）发生率分别为 14%和 32%。与开腹手术相比，腹腔镜手术导致术后手术部位感染（SSI）的发生率显著降低（4.5%比 32%；P=0.0053）。
腹腔镜姑息性手术治疗 MBO 是安全可行的，并且与较低的 SSI 发生率相关。通过降低术后发病率，腹腔镜方法可能对预期寿命有限的 MBO 患者带来显著获益。
