Department of Colorectal Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang, People's Republic of China.
Postgraduate Training Base Alliance of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang, People's Republic of China.
World J Surg Oncol. 2023 Oct 21;21(1):331. doi: 10.1186/s12957-023-03228-x.
This study aimed to conduct a case-control study of endoscopic and fluoroscopic metal stent placement combined with laparoscopic surgery versus conventional open Hartmann's procedure in treating acute left-sided colon cancer obstruction. Additionally, the study aims to discuss the application value of endoscopic and X-ray-guided metal stent placement combined with laparoscopic surgery in the treatment of acute left-sided colon cancer obstruction.
From June 2011 to December 2019, 23 patients with acute left-sided colon cancer obstruction who underwent metal stent implantation combined with laparoscopic surgery under endoscopy and X-ray fluoroscopy in Wenzhou Central Hospital were collected, and 20 patients with acute left-sided colon cancer obstruction who underwent traditional emergency open Hartmann's surgery during the same period were selected as a control group. All patients were diagnosed with left colon obstruction by plain abdominal film and/or CT before the operation and colon adenocarcinoma by colonoscopic biopsy and/or postoperative pathology. The operation time, intraoperative blood loss, postoperative anal exhaust time, the success rate of one-stage anastomosis, postoperative hospital stay, and postoperative complications were compared between the two groups.
This study showed a significant difference in the therapeutic effect between the two groups. Compared with the traditional Hartmann's operation group, the success rate of one-stage anastomosis in endoscopic and X-ray-guided metal stent placement combined with the laparoscopic operation group was significantly higher than that in the Hartmann's operation group (P < 0.05). The overall incidence of postoperative complications and hospital stay were significantly lower in the observation group than in the Hartmann's group (P < 0.05). Further subgroup analysis of the overall postoperative complication rate of the two groups showed that the traditional Hartmann's operation group was more likely to have an incomplete intestinal obstruction (P < 0.05). This study also showed no significant differences between the two groups in operation time, intraoperative blood loss, number of harvested lymph nodes, and postoperative anal exhaust time (all P > 0.05). This study also found no significant differences between the two groups in overall survival rates or recurrence-free survival rates (all P > 0.05).
The comparison of the therapeutic effects of the two groups verified the feasibility of endoscopy combined with X-ray fluoroscopy metal stent placement in combination with laparoscopic surgery in the treatment of acute left-sided colon cancer obstruction. Compared with the traditional emergency open Hartmann's procedure, metal stent implantation under endoscopy and X-ray fluoroscopy combined with laparoscopic surgery is more minimally invasive, safe, and effective. It avoids the traditional second or even third surgical trauma to effectively improve the quality of life of patients, so that patients can recover quickly after surgery.
本研究旨在对内镜和透视金属支架置入联合腹腔镜手术与传统开腹 Hartmann 手术治疗急性左半结肠癌梗阻进行病例对照研究，并探讨内镜和透视引导下金属支架置入联合腹腔镜手术治疗急性左半结肠癌梗阻的应用价值。
收集 2011 年 6 月至 2019 年 12 月在温州市中心医院行内镜和透视下金属支架置入联合腹腔镜手术的 23 例急性左半结肠癌梗阻患者，同期选择 20 例急性左半结肠癌梗阻行传统急诊开腹 Hartmann 手术患者作为对照组。所有患者术前均经腹部平片和/或 CT 诊断为左半结肠梗阻，经结肠镜活检和/或术后病理诊断为结肠腺癌。比较两组患者的手术时间、术中出血量、术后肛门排气时间、一期吻合成功率、术后住院时间及术后并发症。
两组患者的治疗效果存在显著差异。与传统 Hartmann 手术组相比，内镜和透视引导下金属支架置入联合腹腔镜手术组的一期吻合成功率明显高于 Hartmann 手术组（P<0.05）。观察组术后并发症总发生率和住院时间均明显低于 Hartmann 组（P<0.05）。进一步对两组患者术后总并发症发生率进行亚组分析，发现传统 Hartmann 手术组更易发生不完全性肠梗阻（P<0.05）。本研究还发现两组患者的手术时间、术中出血量、淋巴结清扫数目和术后肛门排气时间无显著差异（均 P>0.05）。两组患者的总生存率和无复发生存率也无显著差异（均 P>0.05）。
两组疗效比较验证了内镜联合透视下金属支架置入联合腹腔镜手术治疗急性左半结肠癌梗阻的可行性。与传统急诊开腹 Hartmann 术式相比，内镜和透视下金属支架置入联合腹腔镜手术更为微创、安全、有效，避免了传统的二次甚至三次手术创伤，有效提高了患者的生活质量，使患者术后能快速康复。
