To explore the clinical curative effect of enteroscopic stent implantation combined with laparoscopy in patients with colorectal cancer and intestinal obstruction. A retrospective analysis was performed on the data of patients with colorectal cancer and intestinal obstruction in Gastrointestinal Surgery of Henan Provincial People's Hospital between November 2019 and October 2020. Among patients, there were 46 cases in traditional group (laparotomy+intraoperative intestinal irrigation), 42 cases in stent-laparotomy group (enteroscopic stent implantation+laparotomy), and 41 cases in stent-laparoscopy group (enteroscopic stent implantation+laparoscopy). The perioperative situation, levels of biochemical indexes, peripheral serum carcinoembryonic antigen (CEA) and carbohydrate antigen 199 (CA199), and prognosis were compared among the three groups. The results showed that among the three groups, operation time [(203.6±30.5) min] was longer, postoperative exhaust time [(1.2±0.3) d] and length of hospital stay [(10.5±2.1) d] were shorter, and intraoperative blood loss [(102.5±22.3) ml] was less in stent-laparoscopy group (all P values<0.05). The incidence of postoperative complications in stent-laparoscopy group was lower than that in traditional group (4.8% vs 21.7%, P<0.05). At 1 day after surgery, EOS was decreased, while PLT and CRP were increased in all three groups. Compared with traditional group and stent-laparotomy group after surgery, EOS was increased, while PLT and CRP were decreased in stent-laparoscopy group [EOS: (4.2±0.2) % vs (3.6±0.3) % vs (3.9±0.2) %; PLT: (259.6±11.4)×109/L vs (294.4±11.5)×109/L vs (271.7±10.7)×109/L; CRP: (8.8±2.0) vs (16.4±2.2) vs (14.9±2.3) ng/L; P<0.05]. At 3 months after surgery, levels of serum CEA and CA199 were decreased in the three groups. There was no significant statistical difference in serum CEA or CA199 among the three groups. During 3 years of follow-up, there was no significant statistical difference in postoperative recurrence rate or incidence of postoperative metastasis among the three groups. The study indicated that enteroscopic stent implantation combined with laparoscopy was more advantageous in terms of reducing intraoperative blood loss, accelerating recovery of postoperative exhaust function, relieving surgical stress and reducing the incidence of postoperative complications, which could decrease levels of serum CEA and CA199.
探讨肠镜下支架置入联合腹腔镜手术治疗结直肠癌并肠梗阻患者临床效果。回顾性分析2019年11月至2020年10月在河南省人民医院胃肠外科行开腹手术+术中肠腔冲洗治疗（46例，传统组）、肠镜下支架置入+开腹手术（42例，支架开腹组）、肠镜下支架置入+腹腔镜手术（41例，支架腹腔镜组）治疗结直肠癌并肠梗阻患者病例资料，比较3组患者围手术期情况、生化指标、外周血癌胚抗原（CEA）、糖类抗原199（CA199）水平和预后。结果显示，3组患者中，支架腹腔镜组手术时间［（203.6±30.5）min］较长，术后排气时间［（1.2±0.3）d］、住院时间［（10.5±2.1）d］较短，术中出血量［（102.5±22.3）ml］较少（均P<0.05）。支架腹腔镜组术后并发症发生率低于传统组（4.8%比21.7%）（P<0.05）。术后1 d时，与术前相比，3组嗜酸性粒细胞（EOS）均降低，血小板计数（PLT）、C反应蛋白（CRP）均升高；3组患者中，支架腹腔镜组术后EOS较支架开腹组升高，PLT、CRP均降低［EOS：（4.2±0.2）%比（3.6±0.3）%比（3.9±0.2）%；PLT：（259.6±11.4）×109/L比（294.4±11.5）×109/L比（271.7±10.7）×109/L；CRP：（8.8±2.0）比（16.4±2.2）比（14.9±2.3）ng/L；均P<0.05］。术后3个月时，与术前相比，3组血清CEA、CA199水平降低；3组患者中，血清CEA、CA199水平比较差异均无统计学意义。随访3年内，3组术后复发率、术后转移发生率比较差异均无统计学意义。本研究表明，肠镜下支架置入联合腹腔镜手术在降低术中出血量、加快患者术后排气功能恢复、缓解患者手术应激和降低术后并发症发生率方面更具优势，能降低患者术后血清CEA、CA199水平。.