摘要
目的本研究旨在比较支架置入术后择期手术与急诊手术治疗急性右半结肠恶性梗阻的临床价值和远期预后。方法选取2010年1月至2018年5月在中国科学院大学宁波华美医院因急性右半结肠恶性梗阻行支架置入后择期手术的25例患者作为病例组(支架组)。以年龄、性别、肿瘤大小和位置以及TNM分期5个协变量作为患者的基线特征。采用1∶2最邻近匹配法匹配该院同时期因急性右半结肠恶性梗阻行急诊手术的230例患者,以均衡两组患者的协变量。经倾向评分匹配后,急诊手术组纳入50例患者。结果支架置入术治疗急性右半结肠恶性梗阻的技术成功率和临床成功率分别为100%和96.0%。支架组接受腹腔镜手术的比例明显高于急诊手术组,平均手术时间明显低于急诊手术组,差异具有统计学意义(P<0.05)。与急诊手术组相比,支架组术后并发症发生率明显降低,术后住院时间明显缩短,差异均具有统计学意义(P<0.05)。两组间术后30 d死亡率、5年无病生存率和总生存率对比均无统计学差异(P>0.05)。结论支架置入术治疗急性右半结肠恶性梗阻具有一定的安全性和可行性。支架置入术作为外科手术的桥梁,可增加急性右半结肠恶性梗阻患者接受微创手术的机会,缩短手术时间,降低患者并发症发生率、缩短住院时间,可作为治疗急性右半结肠梗阻的一项选择。
Objective The purpose of this study was to compare the clinical value and long-term prognosis of elective surgery after stent implantation with those of emergency surgery in the treatment of acute malignant obstruction of the right hemicolon.Methods 25 patients who had undergone elective surgery after stenting for acute malignant obstruction of right hemicolon from January 2010 to May 2018 in Ningbo Huamei Hospital,University of Chinese Academy of Sciences were selected as a case group(stent group).Age,gender,tumor size and location and TNM stage were used as the baseline characteristics of patients.The 1:2 nearest neighbor-matching method was used to match 230 patients who had received emergency surgery for acute malignant obstruction of the right colon during the same period,which balanced the covariates in the two groups.After being matched via propensity score,50 patients were included in an emergency operation group.Results The technical success rate of stent implantation for acute malignant obstruction of the right hemicolon was 100%while the clinical success rate was96.0%.The proportion of laparoscopic surgery was significantly higher but the surgical duration was markedly shorter in the stent group than in the emergency operation group(P<0.05).As compared with the emergency operation group,the incidence of postoperative complications and the length of postoperative hospital stay were significantly reduced in the stent group(P<0.05).There were no significant differences in 30-day mortality,5-year disease-free survival and overall survival between the two groups(P>0.05).Conclusions Stent implantation is safe and feasible in the treatment of acute malignant obstruction of the right hemicolon.As a bridge of surgery,stent implantation can increase the chance of minimally invasive surgery for patients with acute right hemicolon malignant obstruction,shorten the surgical duration and the length of hospital stay,and reduce the incidence of complications.It can be used as an option for the treatment of acute right
作者
李鹏莉
石定
LI Pengli;SHI Ding(He’nan University of Chinese Medicine,Zhengzhou 450046,China;不详)
出处
《实用医学杂志》
CAS
北大核心
2022年第1期79-84,共6页
The Journal of Practical Medicine
关键词
支架
右侧结肠癌
急性肠梗阻
择期手术
急诊手术
stent
right colon cancer
acute intestinal obstruction
elective surgery
emergency surgery
