近段和远段结直肠癌伴急性梗阻的治疗与预后  

Analysis of the diagnosis, treatment and prognosis in acute obstruction of proximal and distalcolorectal cancers

作　　者：王中林[1] 潘杰[2] 潘忠良[1] 孙伟[1] 

机构地区：[1]温州市中心医院温州医学院定理临床学院普通外科,325027 [2]温州市中心医院温州医学院定理临床学院消化内科,325027

出　　处：《中华肿瘤杂志》2013年第1期59-62,共4页Chinese Journal of Oncology

摘　　要：目的比较近段和远段结直肠癌伴急性梗阻的不同治疗策略和预后，探讨影响围手术期并发症的危险因素。方法回顾性分析行手术治疗的184例结直肠癌急性梗阻患者的临床资料，评价其治疗效果与预后。结果184例患者中，近段结肠梗阻（近段组）58例，远段结直肠梗阻（远段组）126例。近段组患者死亡2例，远段组死亡6例，差异无统计学意义（P〉0．05）。在远段结直肠梗阻患者中，支架组行结肠造瘘1例，急诊手术组为40例，差异有统计学意义（P=0．002）。支架组患者的住院时间[（25．4±8．3）d]和住院费用[（43623．2±7935．7）元]与急诊手术组[分别为（32．8±16．4）d和（25645．9±8519．0）元]比较，差异均有统计学意义（均P〈0．05）。美国麻醉医师协会病情分级、年龄〉170岁、结肠穿孔腹膜炎是影响结直肠癌患者预后的独立因素。结论肠道金属支架植入为左半结肠癌、直肠癌所致的急性梗阻患者提供了一种更小创伤、更易接受的新的治疗方法。Objective The study aimed to review the treatment and prognosis of acute obstruction of colorectal cancers and to compare different treatment strategies of those cancers, and to evaluate the risk factors affecting perioperative complications. Methods Clinical data of 184 patients with acute obstruction of colorectal cancer undergone operation were analyzed retrospectively. Results A total of 184 patients with acute obstruction of colorectal cancer was collected in this study, including 58 patients with proximal and 126 patients of distal colorectal cancers. Perioperative death occurred in 2/58 patients （ 3.4% ） with distal colorectal cancer and 6/126 cases （4.8 % ） of distal colorectal cancer （P 〉 0. 05 ）. The overall perioperative complications in the two groups were not significantly different （ P = 0. 794 ）. Among the 58 patients with proximal colorectal cancer, one patient underwent colostomy, but among the 126 patients with distal colorectal cancer, 41 patients underwent colostomy, showing a significant difference between the two groups （P = 0. 002 ）. ASA scores （grade 3-4 ）, elderly age （ 1〉 70 years ） and colon perforation peritonitis were independent prognostic factors associated with perioperative mortality and morbidity. Patients in the self- expandable metallic stent （SEMS） group had a significantly shorter hospital stay （25.4 ± 8.3 ） d than that in the emergency surgery group （32.8 ± 16.4） d , （P = 0. 039）. Conclusions Endoscopic stent implantation provides an acceptable modality of palliation for acute proximal large bowel obstruction caused by malignancies. In acute colorectal cancer obstruction, SEMS can provide a minimally invasive management compared with surgical intervention.

关 键 词：结直肠肿瘤 肠梗阻 支架 预后 

分 类 号：R735.3[医药卫生—肿瘤]