肠道支架减压在左侧大肠癌梗阻一期切除吻合中的应用  

Application of self-expanding metallic stents in one-stage surgery for left-sided malignant colorectal obstruction

作　　者：裘华森[1] 吕宾[2] 张勤[1] 周济春[1] 郑超[1] 茅巍[1] 

机构地区：[1]浙江中医药大学附属第一医院胃肠外科,杭州310006 [2]浙江中医药大学附属第一医院消化外科,杭州310006

出　　处：《中华消化外科杂志》2009年第6期432-434,共3页Chinese Journal of Digestive Surgery

摘　　要：目的探讨术前肠道支架减压在左侧大肠癌梗阻一期切除吻合中运用的安全性和有效性。方法回顾性分析2005年5月至2008年9月浙江中医药大学附属第一医院收治的97例左侧大肠癌患者临床资料。支架联合手术组46例，为左侧大肠癌合并肠梗阻的患者，成功放置肠道支架减压后行手术一期切除吻合治疗。单纯手术组51例，为无梗阻的左侧大肠癌而限期手术治疗的患者。观察两组患者术后胃肠功能恢复、术后住院时间、并发症发生情况。采用t检验、χ2检验对数据进行分析。结果支架联合手术组46例中，1例乙状结肠癌患者于肠道支架植入术后第4天出现肠道穿孔致弥漫性腹膜炎，急诊行乙状结肠癌根治术。45例均顺利完成一期手术治疗，术后11—16d痊愈出院，1例患者术后10d死于呼吸道感染及心功能衰竭。术后随访4—48个月。两组患者在术后肛门排气时间、住院时间、围手术期并发症发生率、复发转移率、随访期内生存率方面比较差异无统计学意义（t=0．164，1．358，χ2=0．252，1．200，0．580，P〉0．05）。结论术前肠道支架减压是治疗左侧大肠癌梗阻患者安全、有效的方法。Objective To evaluate the safety and efficacy of self-expanding metallic stents （SEMS） in one-stage surgery for patients with left-sided malignant eoloreetal obstruction. Methods The clinical data of 97 patients with left-sided coloreetal cancer who had been admitted to the First Affiliated Hospital of Zhejiang Chinese Medical University from May 2005 to September 2008 were retrospectively analyzed. Forty-six patients with leftsided malignant colorectal obstruction were in the test group, after the placement of SEMS, they received one-stage resection and anastomosis; 51 patients with left-sided eoloreetal cancer （without obstruction） were in the control group, and they received one-stage surgery. The defecation and anal exhaust time, hospital stay and incidence of postoperative complications between the 2 groups were analyzed. All data were analyzed via t test or ehi-square test. Results One patient in test group had acute diffuse peritonitis which was induced by intestinal perforation at postoperative day 4, and was treated with radical resection for sigmoid cancer. One-stage surgery was successfully performed on 45 patients, and they were discharged at postoperative day 11-16. One patient died of respiratory infection and heart failure at postoperative day 10. All patients were followed up for 4-48 months. There was no significant difference in defecation and anal exhaust time, hospital stay, incidence of perioperative complications, recurrence, metastasis and survival within follow-up interval between the 2 groups （t = 0. 164, 1. 358, χ2 = 0. 252, 1. 200, 0. 580, P 〉 0.05 ）. Conclusion SEMS is effective and safe in the treatment of left-sided malignant colorectal obstruction.

关 键 词：大肠肿瘤 肠梗阻 肠道支架 一期手术 

分 类 号：R735.34[医药卫生—肿瘤] R656.7[医药卫生—临床医学]