摘要
目的评估肠道支架联合手术在左半结肠癌合并急性肠梗阻患者的应用价值及疗效。方法回顾性分析成都市第二人民医院普外一科2016年9月至2019年9月期间收治的左半结肠癌合并急性肠梗阻60例患者的临床资料,分为支架组24例和对照组36例,支架组先置入肠道支架,梗阻缓解后限期手术;对照组常规急诊手术。结果两组的手术时间、出血量、术后肛门排气时间、术后住院时间、并发症发生率、围手术期死亡率差异均无统计学意义(均P>0.05)。两组的3年总体生存率和复发转移率差异无统计学意义(χ2=0.515、0.448,均P>0.05)。支架组术前肠道准备率明显高于对照组(100%比44%,P=0.000)、腹腔镜手术率高于对照组(21%比0,χ2=9.857,P=0.002)、造口率低于对照组(0比19%,χ2=10.237,P=0.005)、一期切除吻合率高于对照组(100%比81%,χ2=7.760,P=0.005)、淋巴结检出数多于对照组[11(7~14)枚比6(3~10)枚,Z=-2.672,P=0.006]。结论对于左半结肠癌合并急性梗阻患者,肠道支架可改善肠道准备情况,提高一期吻合率,减少肠造口;同时可提高腹腔镜手术比例,增加淋巴结清扫数,在一定程度上改善患者的生活质量。
Objective To evaluate intestinal stenting in patients of left colon cancer complicated with acute intestinal obstruction and analyze its short-term and long-term efficacy.Methods Sixty patients who suffered from left colon cancer complicated with acute intestinal obstruction at the First Department of General surgery,Chengdu Second People's Hospital from Sep 2016 to Sep 2019 were retrospectively enrolled.According to treatment methods,the patients were divided into the stent implantation staged surgery group(24 patients)and the control group receiving emergency surgery(36 patients).Results There was no significant difference in perioperative course between the two groups.There was no significant difference in three year overall survival rate or recurrence and metastasis rate between the two groups.Preoperative bowel preparation rate in stent implantation group was obviously higher than the control group(100%vs.44%,P=0.000).The laparoscopic surgery rate of the stent implantation group was higher than the control group(21%vs.0,χ2=9.857,P=0.002).The enterostomy rate of the stent implantation group was lower than the control group(0 vs.19%,χ2=10.237,P=0.005).There was a higher rate of one-stage excision and anastomosis in the stent implantation group than in the control group(100%vs.81%,χ2=7.760,P=0.005).There was a higher lymph nodes deissection rate in the stent implantation group than in the control group,[11(7-14)vs.6(3-10),Z=-2.672,P=0.006].Conclusions For patients who suffered from left colon cancer complicated with acute intestinal obstruction,the intestinal stent can improve the bowel preparation to a greater extent,which can increase the proportion of one-stage anastomosis and reduce enterostomy rate.
作者
黄秋实
何山
沈健
卜君
徐尔侃
文静
Huang Qiushi;He Shan;Shen Jian;Bu Jun;Xu Erkan;Wen Jing(Department of General Surgery,the Second People's Hospital of Chengdu,Chengdu 610017,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2021年第12期910-914,共5页
Chinese Journal of General Surgery
关键词
结肠肿瘤
肠梗阻
支架
Colonic neoplasms
Intestinal obstruction
Stent
