目的：探讨X线辅助内镜置入支架联合腹腔镜治疗结直肠癌并梗阻的临床价值。方法：选择2007年1月—2013年12月75例符合条件的降结肠及直肠癌并梗阻患者，其中37例行X线辅助腹腔镜联合肠镜治疗（联合组），38例行开腹手术加术中结肠灌洗治疗（传统组），比较两组患者的相关临床资料。结果：两组术前资料有可比性。联合组经肠镜置支架成功率89.19%（33/37），腹腔镜手术成功率93.94%（31/33），手术失败的6例患者排除出组。与传统组比较，联合组除治疗费用增加外（3.06万元vs. 2.55万元），术中诊断息肉阳性率（35.48% vs. 7.89%）、根治性切除率（83.9% vs. 71.1%）、术中预防性回肠末端造口（6.45% vs. 23.68%）、手术时间（175.45 min vs. 202.24 min）、切口长度（4.88 cm vs. 16.84 cm）、清扫淋巴结数（16.80枚vs. 11.92枚）、围手术期总并发症及感染相关并发症发生率（16.13% vs. 39.47%；6.45% vs. 26.32%）、术后住院时间（7.36 d vs. 11.05 d）、二期手术率（6.5% vs. 28.9%）、术后3个月肠镜检查发现结直肠息肉阳性率（3.23% vs. 23.68%）方面均有明显优势（均P<0.05）。术后1、3、5年生存率两组差异无统计学意义（均P>0.05）。结论：X线辅助腹腔镜联合肠镜治疗结直肠癌并梗阻安全、可行，且手术根治效果好，能有效降低二期手术率。
Efficacy analysis of X-ray- assisted endoscopic stent placement and laparoscopic resection in treatment of obstructive colorectal cancer
Objective: To assess the clinical value of X-ray-assisted endoscopic stent placement and laparoscopic resection in treatment of obstructive colorectal cancer. Methods: Seventy-five eligible patients with cancer in the descending colon or rectum presenting with obstruction during January 2007 to December 2013 were selected. Of the patients, 37 cases underwent X-ray- assisted endoscopic stent placement and laparoscopic resection (combination group), and 38 cases were subjected to open resection plus intraoperative colonic lavage (conventional group). The main clinical variables between the two groups were compared. Results: The preoperative data between the two groups of patients were comparable. In combination group, the success rate of stent placement via colonoscopic procedure was 89.19% (33/37) and success rate of laparoscopic operation was 3.94% (31/33), and the 6 cases with operative failure were excluded. Compared with conventional group, except for increased cost of treatment (30 600 yuan vs. 25 500 yuan), the combination group showed significant advantages in intraoperative polyp detection rate (35.48% vs. 7.89%), radical resection rate (83.9% vs. 71.1%), rate of intraoperative preventive terminal ileostomy (6.45% vs. 23.68%), operative time (175.45 min vs. 202.24 min), length of incision (4.88 cm vs. 16.84 cm), number of resected lymph nodes (16.80 vs. 11.92), incidence of overall complications and infection-related complications (16.13% vs. 39.47%; 6.45% vs. 26.32%), length of postoperative hospital stay (7.36 d vs. 11.05 d), rate of second-stage surgery (6.5% vs. 28.9%), and positive rate of polyps at 3 months postoperatively (all P<0.05). There was no statistical difference in 1-, 3- and 5-year survival rate between the two groups (all P>0.05). Conclusion: X-ray-assisted colonoscopy combined with laparoscopic resection for obstructive colorectal cancer is safe and feasible, and it also has ideal radical effects and can reduce the rate of second-stage surgery.