结肠镜非透视下自扩张金属支架在处理梗阻性结直肠癌中的临床应用研究  

Clinical study of the application of self-expanding metal stents without fluoroscopic monitoring for malignant colorectal obstruction

作　　者：闫飞虎[1,3] 曹光材[2] 刘小双[1] 王振[1] 毛杰 赵晓光[3] 徐晓东[1] 王颢[1] 王汉涛[1] 傅传刚[1] 于恩达[1] 

机构地区：[1]第二军医大学长海医院肛肠外科,上海200433 [2]延安大学附属医院肛肠外科 [3] 解放军第四一三医院普外科 [4]海军东海舰队参谋部门诊部

出　　处：《中华航海医学与高气压医学杂志》2016年第4期293-297,共5页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

基　　金：长海医院“1255”学科特色培育项目（CH125542500）;上海市科委基础研究项目（13JC1407200）

摘　　要：目的：比较肠镜非透视下金属支架置入序贯手术（SEMS组）与急诊手术（ES组）治疗梗阻性结直肠癌的临床效果。方法回顾性分析2007年10月至2012年12月第二军医大学附属长海医院、解放军第四一三医院收治的60例接受手术治疗的梗阻性结直肠癌患者，SEMS组（27例）接受了金属支架置入序贯手术治疗，ES组（33例）接受了急诊手术治疗。对比分析2组患者的一期切除吻合率、肠造口率、腹腔镜手术率、术后病死率、并发症发生率、ICU转入率、淋巴结清扫数量、手术时间、住院时间、住院费用等指标。所有患者术前均由多学科团队讨论、制定治疗方案。结果 SEMS组患者一期切除吻合率92．6％（25／27），高于ES组的66．7％（22／33），差异有统计学意义（P＝0．015）；SEMS组造口率7．4％（2／27），明显低于ES组的45．5％（15／33），差异有统计学意义（P＝0．001）；SEMS组的腹腔镜手术率14．8％（4／27），高于ES组的0％（0／33），差异有统计学意义（P＝0．035）；SEMS组术后ICU转入率7．4％（2／27），低于ES组的33．0％（11／33），差异有统计学意义（P＝0．015）；SEMS组患者淋巴结清扫数量[（17．52±4．00）枚]，多于ES组[（13．73±6．12）枚]，差异有统计学意义（P＝0．008）；SEMS组患者手术时间（117．22±6．42）min，明显短于ES 组的（173．64±8．32）min，差异有统计学意义（P＜0．01）；SEMS组患者中位住院时间9 d，明显短于ES组的14 d，差异有统计学意义（P＜0．01）；SEMS组患者中位住院费用39183．33元，明显少于ES组的53675．58元，差异有统计学意义（P＜0．001）。SEMS组术后30 d死亡率0％（0／27）、围手术期相关并发症发生率7．4％（2／27），低于ES组的3．0％（1／33）、21．2％（7／33），差异无统计学意义（P＞0．05）。结论 SEMS可有效解除结直肠癌合并的急性Objective To compare the clinical effect of self-expanding metal stents as a bridge to surgery （the SEMS group）with those of emergency surgery （the ES group）for malignant colorectal obstruction （MCO）.Methods A retrospective analysis was made on the 60 cases of MCO that received surgical treatment in Changhai Hospital of the Second Military Medical University and No.413 Hospital from October 2007 to＆amp;nbsp;December 2012.The SEMS group （27 cases）received self -expanding metal stents,while the ES group （33 cases）was treated with emergency surgery.Indexes,such as primary anastomotic rate,stoma rate, laparoscopic surgical rate,death rate after surgery,postoperative complication rate,ICU transfer rate,the number of lymph nodes cleared,surgical time,length of hospital stay and hospitalization cost,were compared between the 2 groups. Before surgery, the medical team consisting of multidisciplinary specialists held discussions on the treatment schemes and appropriate surgical protocols were developed pertaining to individual cases.Results Primary anastomotic rate of the patients in the SEMS group （92.6%,25/27）was significantly higher than that of the patients in the ES group （66.7%,22/33）（P=0.015）.Stoma rate of the SEMS group （7.4%,2/27）was significantly lower than that of the ES group （45.5%,15/33）（P=0.001）.Laparoscopic surgical rate of the SEMS group （14.8%,4/27）was obviously higher than that of the ES group （0%,0/33） （P=0.035）.ICU transfer rate of the SEMS group （7.4%,2/27）was significantly lower than that of the ES group （33.3%,11/33）（P=0.015）.The number of lymph nodes cleared for the SEMS group（17.52 ± 4.00）was larger than that for the ES group （13.73 ±6.12）（P=0.008）.Surgical time for the SEMS group （117.22 ±6.42）min was significantly shorter than that for the ES group （173.64 ±8.32）min （P〈0.01）. Length of hospital stay for the SEMS group （9 d）was significantly shorter than that for the ES group （14 d） （P�

关 键 词：支架 急诊外科 肠梗阻 结直肠癌 

分 类 号：R735.34[医药卫生—肿瘤]