肠道支架在结直肠癌性梗阻中的临床应用  

Clinical application of metal stent in the treatment of colorectal cancer obstruction

作　　者：张瑞[1] 武书胜[1] 侯波[1] 李宏伟[1] 赵保玉[1] 

机构地区：[1]山西省人民医院普外科一病区,太原 030012

出　　处：《中国实用医刊》2013年第15期14-16,共3页Chinese Journal of Practical Medicine

摘　　要：目的评价结直肠癌性梗阻急诊手术与在内镜下金属支架置入后择期手术的临床疗效。方法选择30例有手术指征的癌性梗阻患者接受急诊手术，28例癌性梗阻并有手术指征的患者接受支架置入术，作为肠道准备的过渡性治疗，3—5d后行结直肠癌根治术，一期吻合。对比手术并发症发生率、住院费用及住院时间。结果30例急诊手术患者，27例行结直肠癌根治，近端造瘘、远端封闭术，3个月后行造瘘还纳，1例行根治性切除，近端造瘘、远端封闭后4d因多脏器功能衰竭死亡，2例肿瘤晚期无法切除行近端造瘘术。27例癌性梗阻患者成功置入支架，1例因肠腔闭塞置入失败，支架置入后即出现排便，积极肠道准备，3～5d后行结直肠癌根治术，一期吻合。择期手术组的并发症发生率、住院费用、住院时间明显低于急诊手术组，差异有统计学意义（P〈0．05）。结论结直肠癌性梗阻患者在内镜下金属支架置入解除梗阻后择期手术，可降低患者的费用，缩短住院时间，提高生活质量。Objective To evaluate the clinical efficacy of emergency operation and elective op- eration after intestinal metal stents on obstructive colorectal cancer. Methods Thirty surgically indicated patients with colorectal obstruction underwent emergency surgery. Twenty-eight patients underwent metal stent placement as transitional treatment, and underwent radical resection of colorectal cancer after 3 -5 days, one-stage operation. Surgical complication rates, hospital costs and length of stay were observed in treated patients. Results About 27 of total 30 patients received emergency operation （ proximal colosto- my and remote closed）, and the stoma was returned after 3 months. One case was dead due to multiple organ failure, 4 days after operation, and two late-stage cancer patients received colorectal gastrostomy, because the tumors can not beremoved. Metal stents were performed in 27 of total 28 patients, the proce- dure failed in one case, because the colon was entirely blocked. Defecation occurred after colon bracket insertion operation under endoscopy, and radical resections of colorectal cancer （one-stage operation ） were peformed after bowel preparation for 3 -5 days. There were significant differences between the two groups in surgical complication rates, hospital costs and length of stay （ P 〈 0. 05 ）. Conclusions Color- ectal cancer obstruction patients underwent radical resection of colorectal cancer, one-stage operation, af-ter relief of obstruction by metal stents, which can shorten hospital stay, reduce the cost ofhospitalization, and improve the quality of life.

关 键 词：结直肠癌 肠梗阻 金属支架 

分 类 号：R735.3[医药卫生—肿瘤]