摘要目的:观察自膨式金属支架（SEMS）置入术后不同时间点行腹腔镜手术对结肠癌并肠梗阻患者胃肠功能及血清癌胚抗原（CEA）、糖类抗原199（CA199）的影响。方法:收集2017年12月至2022年12月河南省人民医院收治的89例结肠癌合并肠梗阻患者。根据择期腹腔镜不同手术时机将患者分为A组（SEMS置入时间≤14 d行腹腔镜手术，38例）、B组（SEMS置入时间>14 d行腹腔镜手术，51例）。记录患者术中出血量、手术时间、淋巴结清扫数量、住院时间、肛门排气时间、排便时间、进流食时间。电化学发光免疫法检测术后5 d血清糖类抗原125（CA125）、CEA、CA199水平。统计患者并发症情况。随访患者术后1年的总生存率。随访患者术后1年的总生存率，Kaplan-Meier法描绘结肠癌合并肠梗阻患者总生存率曲线，log-rank检测统计学显著性。结果:两组的术中出血量[A组：（58.76±6.03） ml，B组：（59.84±6.11） ml]、手术时间[A组：（118.72±28.53） min，B组：（118.72±28.53） min]、淋巴结清扫数量[A组：（11.77±2.53）枚，B组：（11.93±2.61）枚]、住院时间[A组：（7.74±1.33） d，B组：（7.63±1.21） d]经统计学比较差异无统计学意义（ P>0.05）。A组的肛门排气时间、排便时间、进流食时间[（1.48±0.18）、（5.23±0.63）、（5.12±0.68） d]均短于B组[（1.57±0.20）、（5.94±0.74）、（5.64±0.74） d， P<0.05]。A组术后血清CA125、CEA、CA199水平[（31.58±3.45） U/ml、（4.35±0.51） ng/ml、（24.36±2.87） U/ml]低于B组[（36.77±3.71） U/ml、（4.63±0.66） ng/ml、（28.96±3.11） U/ml， P<0.05]。两组总并发症发生率（A组：13.16%，B组：15.69%）、1年总生存率（A组：44.74%，B组：49.02%）经统计学比较差异无统计学意义（ P>0.05）。 结论:结肠癌合并肠梗阻患者SEMS植入术后≤14 d内行择期腹腔镜下结肠癌根治术的疗效优于术后>14 d行择期腹腔镜手术，可促进术后恢复，降低血清肿瘤标志物，且不会增加术后并发症发生率，具有一定安全性，但在短期预后方面无明显优势。

abstractsObjective:To observe the effects of laparoscopic surgery on gastrointestinal function, serum carcinoembryonic antigen (CEA) and carbohydrate antigen 199 (CA199) in patients with colon cancer and intestinal obstruction after self-expandable metal stent (SEMS) implantation.Methods:A total of 89 patients with colon cancer and intestinal obstruction in the hospital were retrospectively collected between December 2017 and December 2022. According to different timing of laparoscopic surgery, patients were divided into group A (laparoscopic surgery within ≤14 d after SEMS implantation, n=38) and group B (>14 d, n=51). The intraoperative blood loss, operation time, number of lymph node dissection, hospitalization time, anal exhaust time, defecation time and eating liquid time were recorded. The levels of serum carbohydrate antigen 125 (CA125), CEA and CA199 were detected by electrochemiluminescence immunoassay at 5th d after surgery. The complications were statistically analyzed. The 1-year overall survival rate after surgery was followed up. The curves of total survival rates were drawn by Kaplan-Meier method, Log-rank test for statistical significance. Results:There was no significant difference in intraoperative blood loss, operation time, number of lymph node dissection or hospitalization time between group A and group B [ (58.76±6.03) vs. (59.84±6.11) ml, (118.72±28.53) vs. (118.72±28.53) min, 11.77±2.53 vs. 11.93±2.61, (7.74±1.33) d vs. (7.63±1.21) d, P>0.05]. The anal exhaust time, defecation time and eating liquid time in group A were (1.48±0.18), (5.23±0.63) and (5.12±0.68) d respectively, shorter than those in group B [ (1.57±0.20), (5.94±0.74), (5.64±0.74) d, P<0.05], and levels of serum CA125, CEA and CA199 were (31.58±3.45) U/ml, (4.35±0.51) ng/ml and (24.36±2.87) U/ml respectively, lower than those in group B [ (36.77±3.71) U/ml, (4.63±0.66) ng/ml, (28.96±3.11) U/ml, P<0.05]. There was no significant difference in total incidence of complications or 1-year overall survival rate between group A and group B (13.16% vs. 15.69%, 44.74% vs. 49.02%, P>0.05) . Conclusion:Compared with laparoscopic surgery within >14 d after SEMS implantation, curative effect of laparoscopic surgery within ≤14 d after SEMS implantation is better in patients with colon cancer and intestinal obstruction, which can promote postoperative recovery and reduce serum tumor markers, with low incidence of postoperative complications and certain safety. However, it has no obvious advantages in terms of short-term prognosis.