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早期外科手术干预对腹腔镜胃癌根治术后胃肠道瘘患者预后的影响
作者:李坤  韩晓鹏  曹廷宝  苏琳  刘宏斌 
单位:兰州军区兰州总医院普外科  甘肃 兰州 730050 
关键词:胃肿瘤 胃切除术/副作用 腹腔镜检查 外科手术 微创性/副作用 手术后并发症 肠瘘/外科学 预后 回顾性研究 
DOI:R735.2
出版年,卷(期):页码:2015,30(3):229-231
摘要:
目的 探讨早期外科手术干预对腹腔镜胃癌根治术后胃肠道瘘患者预后的影响。方法 回顾性分析1031例腹腔镜胃癌根治术患者中发生胃肠道瘘的35例患者的临床资料。其中19例急诊全麻下行开腹置管引流的患者作为手术治疗组,16例经原腹腔引流管置入套管冲洗引流的患者作为保守治疗组,比较两组的治疗结果。结果 手术治疗组治愈率为94.7%,保守治疗组治愈率为81.3%,差异无统计学意义(P>0.05)。手术治疗组瘘口愈合时间为(24.58±2.52)天,保守治疗组为(26.44±2.19)天,差异有统计学意义(P<0.05)。手术治疗组平均住院时间为(42.95±2.61)天,保守治疗组为(45.56±3.20)天,差异有统计学意义(P<0.05)。手术治疗组平均住院费用为(9.63±1.61)万元,保守治疗组为(11.13±1.20)万元,差异有统计学意义(P<0.05)。结论 早期外科手术干预相对于传统保守治疗可缩短腹腔镜胃癌根治术后胃肠道瘘患者瘘口愈合时间及住院时间,减少住院费用,改善预后。
Objective To investigate the effect of early surgical intervention on the prognosis of patients with gastrointestinal fistula after laparoscopic radical resection of gastric cancer. Methods Among 1 031 gastric cancer patients receiving laparoscopic radical resection, 35 had gastrointestinal fistula after surgery. Clinical data of these patients were analyzed retrospectively. Laparotomic drainage placement was performed under emergency anesthesia in 19 patients (surgical group), while in 16 cases original drainage tube was used for abdominal drainage (conservative group). The results were compared between two groups. Results The cure rates of surgical and conservative groups were 94.7% and 81.3%, respectively (P>0.05). The fistula healing time of surgical and conservative groups was (24.58±2.52) d and (26.44±2.19) d, respectively (P<0.05). The average length of hospital stay of two groups was (42.95±2.61) d and (45.56±3.20) d, respectively (P<0.05). The average hospitalization expenses of two groups were[(96 300±16 100) Yuan vs (111 300±12 000) Yuan, P<0.05]. Conclusion Early surgical intervention can significantly shorten fistula healing time and length of hospital stay, and also reduce the medical cost for patients with gastrointestinal fistula after laparoscopic radical resection.
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