内镜下支架置入联合新辅助化疗治疗结直肠癌恶性梗阻  

Endoscopic stenting combined with neoadjuvant chemotherapy for treatment of malignant colorectal obstruction

作　　者：吴洁[1] 荣大庆[1] 柳青峰[1] 耿宣[1] 张志强[1] 董齐[1] 王燕庆[1] 

机构地区：[1]辽宁省人民医院普外一科,辽宁省沈阳市110016

出　　处：《世界华人消化杂志》2013年第35期4056-4059,共4页World Chinese Journal of Digestology

基　　金：沈阳市科技计划基金资助项目;No.F12-193-9-25~~

摘　　要：目的:探讨内镜下支架置入联合新辅助化疗治疗结直肠癌恶性梗阻的临床效果.方法:回顾分析辽宁省人民医院普外科2003-2008年收治的结直肠癌恶性肠梗阻患者75例,按治疗方案将患者分为对照组(n=30),采用传统方法治疗;支架组(n=30),采用自膨式金属支架治疗;支架化疗组(n=15)采用自膨式金属支架联合新辅助化疗治疗.结果:在手术治疗的患者中,对照组实施结肠造瘘率高达62.5%,明显高于支架组30.0%(2=4.619,P<0.05)及支架化疗组25.0%(2=4.500,P<0.05);对照组肿瘤切除率达37.5%,明显低于支架组70.0%(2=4.619,P<0.05)及支架化疗组75.0%(2=4.500,P<0.05);其中实施根治性手术的患者中,支架化疗组高达41.7%,明显高于对照组12.5%(2=3.938,P<0.05),对照组与支架组根治手术切除率比较无统计学意义(2=0.059,P>0.05);支架化疗组5年生存率达26.7%,明显高于对照组3.3%(2=5.513,P<0.05),对照组与支架组比较无统计学意义(2=1.071,P>0.05).结论:内镜下金属支架置入联合新辅助化疗可以有效地提高晚期结直肠癌的手术切除率、根治率,延长生存时间,值得临床推广.AIM： To investigate the clinical effect of endo-scopic stenting combined with neoadjuvant chemotherapy in the treatment of malignant colorectal obstruction. METHODS： A retrospective analysis of 75 ma-lignant colorectal obstruction patients who were treated at Liaoning Provincial People＇s Hospital between 2003 and 2008 was performed. The pa-tients were divided into three groups, a control group （n = 30） treated using traditional methods, a stent placement group （n = 30） treated using self-expanding metal stents, and a stent place-ment plus chemotherapy group （n = 15） treated using self-expanding metal stents in combina-tion with neoadjuvant chemotherapy RESULTS： The percentage of surgical patients undergoing colostomy was significantly higher in the control group than in the stent place-ment group and the stent placement plus che-motherapy group （62.5% vs 30.0%, 25.0%, X^2 = 4.619, 4.500, both P 〈 0.05）. The tumor resection rate was significantly lower in the control group than in the stent placement group and the stent placement plus chemotherapy group （37.5% vs 70.0%, 75.0%, X^2=4.619, 4.500, both P 〈 0.05）. The radical surgery rate was significantly higher in the stent placement plus chemotherapy than in the control group （41.7% vs 12.5%, X^2 = 3.938, P 〈 0.05）, but showed no significant difference between the control group and stent placement group （X^2 = 0.059, P 〉 0.05）. The five-year sur- vival rate was significantly higher in the stent placement plus chemotherapy group than in the control group （26.7% vs 3.3%, X^2 = 5.513, P 〈 0.05）, but showed no significant difference between the control group and stent placement group （X^2 = 1.071, P 〉 0.05）. CONCLUSION： Endoscopic stenting combined with neoadjuvant chemotherapy can effectively improve tumor resection rate and radical sur-gery rate and prolong survival time in patients with advanced colorectal cancer.

关 键 词：支架置入 新辅助化疗 恶性肠梗阻 

分 类 号：R735.3[医药卫生—肿瘤]