Application Of Stent Combined With Laparoscopy In The Treatment Of Left-sided Colorectal Cancer With Acute Intestinal Obstruction

ObjectiveTo explore the clinical effect of intestinal stent combined with laparoscopic surgery in the treatment of acute obstruction of left half colorectal cancer.MethodsThis is a retrospective study.A total of 110 patients with acute complete intestinal obstruction due to radical resectable left-sided colorectal cancer from Emergency surgery of the First Affiliated Hospital of Nanchang University were included between February 2015 and April 2019.According to the different treatment methods,the patients were divided into emergency laparotomy group(n=32),stent combined with laparotomy group(n=31)and stent combined with laparoscopy group(n=47).Clinical and demographic characteristics of the study population were collected.We compared variables of intra-operation(the operation time,intraoperative blood loss,number of lymph node dissection and colostomy rate),variables of post-operation(postoperative intestinal recovery time,complication rate,intensive care observation rate,the length of postoperative hospital stay and the hospitalization expenses)in the three groups.Continuous variables were compared using the variance analysis or the rank sum test.Categorical variables were compared using the Chi-square test or the Fisher exact test.Result1.Clinical and demographic characteristics of the study populationThere is no significant difference in age,sex,hemoglobin,blood albumin,carcinoembryonic antigen,tumor size,the sites of tumors,TNM stages and ASA classification(p>0.05).2.Comparison of the stent placement successful rate and durationThe stent placement successful rates of the stent combined with laparotomy group and stent combined with laparoscopy group were both 100%.There is no significant difference in the duration of the stent placement(p=0.101).3.Comparison of the variables of intra-operation among groupsThe colostomy rate in the stent combined with laparoscopy group was significantly lower than the other two groups(p<0.01).The operation time and number of lymph node dissection in the stent combined with laparoscopy group were significantly bigger than the other two groups(p<0.01).There is no significant difference in the intraoperative blood loss among groups(p=0.934).4.Comparison of the variables of post-operation among groupsThe postoperative intestinal recovery time,intensive care observation rate and the hospitalization expenses in the stent combined with laparoscopy group and stent combined with laparoscopy group were both significantly lower than the emergency laparotomy group(p<0.05).But the complication rate and the length of postoperative hospital stay among groups were similar(p=1.000;p=0.470).Conclusion1.The application of intestinal stent in left half colorectal cancer with acute intestinal obstruction is safe and reliable.2.Compared with emergency open surgery,stent combined with laparoscopic surgery has the characteristics of low colostomy rate,short postoperative intestinal recovery time,low intensive care observation rate and low hospitalization expenses as well as others,which achieved the clinical effect of minimally invasive therapy and rapid recovery.