Applied Research Of Stent Placement Combined With Laparoscopic Operation In The Management Of Acute Left-sided Colorectal Malignant Obstruction

Objective:To investigate the clinical advantages of stent placement combined with laparoscopic operation in the management of acute left-sided colorectal malignant obstruction.Methods:From July 2014 to December 2015,62 patients diagnosed acute left-sided colorectal malignant obstruction,were treated with stent placement in the first Nan Chang university-affiliated hospital,included the selective operation group after stent placement 38 patients,the palliative group after stent placement 20 patients and4 patients with stent related complications in the emergency operation group.According to the surgery methods,patients in the selective operation group were divided into two groups,there were 18 patients in the stent combined with laparoscopy group,and there were 20 patients in the stent combined with laparatomy group,both as the experiment groups.From July 2014 to December 2014,120 patients diagnosed left-sided colorectal cancer without obstructive symptoms,as the control group,were treated with laparoscopic operation in the first Nan Chang universityaffiliated hospital.Analysis of the satety and efficacy of stent placement.The operation time,intraoperative blood loss,postoperative intestinal recovery time,the length of postoperative hospital stay,intensive care observation rate,complication rate,and number of lymph node dissection were compared in following groups:the stent combined with laparoscopy group and the stent combined with laparatomy group,the stent combined with laparoscopy group and the laparoscopic operation group.Results:1.The stent placement successful rate was 96.77%(60/62),the clinical remission rate was 98.33%(59/60),complication rate included perforation3.23%(2/62),stent migration1.72%(1/58),stent obstruction1.67%(1/60).2.The intraoperative blood loss(85.55±37.14)m L,postoperative anal exhaust time(3.11±0.83)d,the length of postoperative hospital stay(8.3±1.24)d in the stent combined with laparoscopy group were significantly less than those in the stent combined with laparatomy group(146.50±39.77)ml?(3.95±0.68)d?(9.40±1.50)d.The number of lymph node dissection(13.22±4.21)?complication rate(5.00%)in the stent combined with laparoscopy group was similar to those in the stent combined with laparatomy group(13.00±4.82)?(5.56%),the differences were no statistically significant(P=0.88>0.05,P=1.00>0.05).The operation time(176.67±27.17)min in the stent combined with laparoscopy group were significantly more than that in the stent combined with laparatomy group(137.00± 14.64)min,the differences were statistically significant(P=0.00 < 0.05).3.The operation time(165.17±23.59)min,intraoperative blood loss(88.17±44.89)ml,postoperative anal exhaust time(3.25±0.65)d,the length of postoperative hospital stay(9.37±2.54)d,number of lymph node dissection(12.65±8.04)in the laparoscopic operation group was similar to those in the stent combined with laparoscopy group(176.67±27.17)min,(85.55±37.14)ml,(3.11± 0.83)d,(8.3±1.24)d,(13.22±4.21).The complication rate 5.56%(1/18),the rate of conversion to open surgery 5.56%(1/18)in the stent combined with laparoscopy group were slightly more than those in the laparoscopic operation group 5%(6/120),5%(6/120),but the differences were no statistically significant(P=1.00).Conclusion:1.Stent in the treatment for acute left-sided colorectal malignant obstruction has high stent placement successful rate,high clinical remission rate,low stent-related complication.2.The effect of stent placement combined with laparoscopic operation in the management of acute left-sided colorectal malignant obstruction is similar to the open operation,and has less intraoperative blood loss,rapid recovery after operation,short length of postoperative hospital stay,less trauma,but has no difference in the complication rate and number of lymph node dissection.3.Preoperation stent placement has no obvious effect on laparoscopic operation.4.The stent placement combined with laparoscopic operation in the management of acute left-sided colorectal malignant obstruction is a safe and effective treatment method and worthy of clinical use.