Endolaparoscopic Approach vs Conventional Open Surgery in the Treatment of Obstructing Left-Sided Colon Cancer A Randomized Controlled Trial
Endolaparoscopic Approach vs Conventional Open Surgery in the Treatment of Obstructing Left-Sided Colon Cancer A Randomized Controlled Trial
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DOI：
10.1001/archsurg.2009.216
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发表时间：
2009-12-01
影响因子：
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通讯作者：
Li, Michael Ka Wah
中科院分区：
文献类型：
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作者：
Cheung, Hester Yui Shan;Chung, Chi Chiu;Li, Michael Ka Wah
目的：比较自膨胀金属支架与急诊开放手术治疗左半结肠癌梗阻的疗效。设计：随机对照试验。环境：急症护理医院。患者：脾脏屈曲和直肠状肌交界处之间有梗阻性肿瘤的成年患者。主要观察指标：一期手术成功，累计手术时间，出血量，住院时间，疼痛评分，术后并发症。结果：对48例患者进行分析。24例行腔内支架置入后行腹腔镜切除，24例行急诊开放手术。两组患者的年龄、性别、体重指数和疾病分期相匹配。腹腔镜组患者累积失血量明显减少，疼痛、吻合口漏、伤口感染发生率明显降低。腹腔镜组i期手术成功率明显高于腹腔镜组（16例vs 9例，P = 0.04）。内镜组无永久性造口，急诊开放组6例（P = .03）。结论：自膨胀金属支架可作为左侧梗阻结肠癌患者后续腹腔镜手术的安全有效的桥梁。这种内镜下入路使一期手术更加可行，减少造口发生率，并使恶性大肠梗阻患者充分享受微创手术的好处。
Objective: To compare self-expanding metal stents with emergency open surgery in the treatment of obstructing left-sided colon cancer.Design: A randomized controlled trial.Setting: An acute care hospital.Patients: Adult patients with an obstructing tumor between the splenic flexure and rectosignioid junction.Main Outcome Measures: Successful I.-stage operation, cumulative operative time, blood loss, hospital stay, pain score, and postoperative complications.Results: Forty-eight patients were analyzed. Twenty-four underwent endoluminal stenting followed by laparoscopic resection and 24 underwent emergency open surgery. The 2 groups were matched for age, sex, body mass index, and disease staging. Patients in the endolaparoscopic group had significantly less cumulative blood loss and lower pain, incidence of anastomotic leak, and Wound infection. Significantly more patients in the endolaparoscopic group had a successful I-stage operation performed (16 vs 9, P = .04). None of the patients in the endolaparoscopic group had a permanent Stoma compared with 6 patients in the emergency open surgery group (P = .03).Conclusions: Self-expanding metal stents serve as a safe and effective bridge to subsequent laparoscopic surgery in patients with obstructing left-sided colon cancer. This endolaparoscopic approach makes a 1-stage operation more feasible, is associated With reduced incidence of stoma creation, and allows patients with malignant large-bowel obstruction to enjoy the full benefit of minimally invasive surgery.