微创外科技术在结直肠癌伴梗阻治疗中的临床应用  

Minimally Invasive Surgical Techniques in Obstructed Colorectal Cancer

作　　者：尚培中[1] 苗建军[1] 贾国洪[1] 南润玲[2] 王兵[2] 钱俊林[3] 

机构地区：[1]中国人民解放军第251医院普外科,河北张家口075000 [2]河北北方学院附属第一医院肿瘤科,河北张家口075000 [3]河北北方学院附属第三医院普外科,河北张家口075000

出　　处：《中国普外基础与临床杂志》2011年第4期406-410,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的 探讨记忆金属支架置入技术、腹腔镜手术及植入用缓释氟尿嘧啶局部化疗3种微创外科方法在治疗结直肠癌伴梗阻中的临床应用价值。方法对解放军第251医院、河北北方学院附属第一医院和第三医院2000年5月至2010年5月期间收治的68例结直肠癌伴梗阻患者分别采用下列2种方法治疗：①对可手术根治的结直肠癌伴梗阻患者，先在结肠镜引导下置人记忆金属肠管支架解除梗阻，施行暂时性过渡治疗，再经充分肠道准备后，腹腔镜下施行根治性切除手术；②对失去手术根治机会的晚期（TNM IV期）直肠癌患者，主要采用支架置入技术，施行永久性姑息治疗，并经支架网眼穿刺植入缓释氟尿嘧啶局部化疗。结果①采用支架置人技术施行过渡治疗，解除梗阻后采用腹腔镜手术52例，其中51例施行根治性切除，1例因侵袭、转移的乙状结肠癌未能切除。获随访41例，随访时间3～36个月，平均15个月。其中施行根治性切除40例，均无局部复发、切口肿瘤种植及吻合口狭窄，另1例未能切除者于术后93d死亡。②对15例失去手术根治机会的晚期直肠癌和l例因患严重肺心病不能耐受手术的直肠癌，采用支架置入和植入用缓释氟尿嘧啶治疗，全部获随访，时间为3～24个月，平均14个月；现已死亡II例，其生存时间为（350±222）d（101～720d）；其余5例已存活3～13个月（平均9个月），未再发生肠梗阻。结论利用记忆金属支架与腹腔镜手术联合治疗可手术根治的结直肠癌伴梗阻患者，具有微创、安全等优点；利用记忆金属支架与植入用缓释氟尿嘧啶联合治疗失去手术根治机会的晚期直肠癌伴梗阻，可使患者避免结肠造口，延长其生存期。Objective To investigate the value of different minimally invasive surgical techniques, stent place- ment, laparoscopic surgery, and sustained-releasing 5 fluorouracil, in solving intestinal obstruction due to colorectal cancer. Methods From May 2000 to May 2010, total 68 patients with obstructed colorectal cancers in three centers were treated in two ways in terms of the stage： The first, patients with resectable tumors underwent colorectal stent placement as a ＇ bridge to surgery＇ guided by enteroscope under X-ray. After clinical decompression and bowel prep aration, laparoscopic radical resection was performed. The second, patients with unresectahle tumors underwent rectal stent placement just for palliation. Sustained-releasing 5-fluorouracil was implanted into the local cancerous in- testinal tract through stent walls. Results Fifty-one of 52 patients underwent laparoscopic radical resection success- fully following stent placement, while one failed and died during follow-up 93 d postoperatively. Forty patients with successful laparoscopic surgery were followed up in 3 to 36 months （with an average of 15 months） without tumor planting in the incision, postoperative local recurrence or anastomotic stricture. Fifteen unresectable patients and one high risk, intolerable patient underwent rectal stent placement and implantation of sustained releasing 5-fluorouracil. During follow-up 3 to 24 months （with an average of 14 months）, 11 died, who survived for （350±222） d （range 101-720 d）, and 5 were still alive for 3 to 13 months （with an average of 9 months） without intestinalobstruction. Conclusions Laparoscopic surgery combined with stent placement is an effective and safe procedure for resectable obstructed colorectal cancer. For unresectal obstructed rectal cancer, rectal stent placement combined with sustained-releasing 5-fluorouracil can prolong survival time avoiding colostomy.

关 键 词：结直肠癌 梗阻 支架 腹腔镜 植入用缓释氟尿嘧啶 姑息治疗 

分 类 号：R735.34[医药卫生—肿瘤] R656.9[医药卫生—临床医学]