| Objective: This retrospective cohort study aims to compare the laparoscopic-assisted surgery with traditional laparotomy in patients with chronic radiation intestinal injury induced intestinal obstruction who accept ileal or ileocecal resection, thereby to evaluate the feasibility and safety of new treatmend approtch.Methods:A total of 32 CRII patients with laparoscopic-assisted terminal ileum and ileocecal resection in our department from Jan,2012 to Jan,2014 and 32 patients with laparotomy from Jan,2011 to Jan,2012 in our department were retrospective reviewed. The age, gender, primary malignancy distribution, total radiation dose, time after radiation therapy, body mass index (BMI), operation time, intraoperative blood loss volume, length of abdomianl incision, duration of postoperative ICU stay, time to first exhaust, time from admission to enteral nutrition onset, length of postoperative hospitalization and the hospitalization cost were evaluated and compared in two group. The reason of intraoperative transferring from laparoscopic-assisted surgery to laparotomy and its relationship with abdominal adhesion were analyzed.Results:No significant difference were detected in intraoperative operation time(159±35min vs 160±38min, p=0.891), intraoperative blood loss volume (100ml(20-200ml) vs 150ml(20-200ml),p=0.0942), duration of postoperative ICU stay (2.0d(0-6d) vs 1.5d(0-6d), p=0.984), postoperative hospitalization (26.5d(12-77d) vs 27d(13-111d), p=0.742), postoperative morbidity(46.9% vs 40.6%, P=0.614) between two group. Patiens in laparoscopic-assisted surgery group had a significant longer time to first exhaust (5.5d(1-22d) vs 4.0d(2-13d), p=0.015) and hospitalization cost (￥90240(￥59785-1337782) vs ￥74246(￥32838-187303), p=0.003). However, length of abdomianl incision (4.5cm(0-25cm) vs 15cm(10-25cm), p==0.000), time to enteral nutrition onset (8.5d(1-22d) vs lld(4-61d), p=0.009) was notably shorter in laparoscopic-assisted surgery group.In total of 9 patients (28,1%) accept laparoscopic-assisted surgery first were transferred to laparotomy, and 6 patients(66.7%) had dense abdominal adhesion. The patients had significantly higher abdominal adhesion grade(p=0.012).Conclusion: Laparoscopic-assisted terminal ileum and ileocecal resection is an efficient and safety approach in CRII patients who need surgery with favorable clinical outcome. To perfume abdominal computed tomography grading before surgery could reduce the rate of transferring from laparoscopic-assisted surgery to laparotomy. |
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