结肠镜非透视下金属支架置入序贯手术治疗梗阻性结直肠癌的临床研究  

Clinical study of endoscopic stenting as a bridge to surgery without fluoroscopic monitoring for malignant colorectal obstruction

作　　者：闫飞虎[1,2] 卞承玲 赵晓光 刘小双[1] 王振 徐晓东[1] 王颢[1] 王汉涛 何海燕 蔡蓓丽 于恩达 

机构地区：[1]中国人民解放军第二军医大学长海医院肛肠外科,上海200433 [2]中国人民解放军第413医院普外科 [3]中国人民解放军第二军医大学长海医院耳鼻喉科,上海200433 [4]中国人民解放军第二军医大学长海医院消化内镜中心,上海200433

出　　处：《临床外科杂志》2017年第8期617-620,共4页Journal of Clinical Surgery

基　　金：长海医院“1255”学科特色培育资助项目(CH125542500);上海市科委基础研究领域资助项目(13JC1407200)

摘　　要：目的比较肠镜下金属支架(self-expanding metallic stents,SEMS)置入序贯手术与急诊手术(emergency surgery,ES)治疗梗阻性结直肠癌的远期肿瘤学效果。方法接受手术治疗的梗阻性结直肠癌病人60例。将60例病人分成两组,ES组33例,接受急诊手术治疗;SEMS组27例,接受非透视下SEMS置入序贯手术。比较两组病人临床病理特征及总体生存率。所有病人术前均由多学科团队讨论、制定治疗方案。结果两组病人一般资料、肿瘤分期、肿瘤部位等比较差异无统计学意义。SEMS组病人中位总体生存时间为37个月,ES组病人为23个月。SEMS组和ES组病人接受术后辅助化疗分别为70.4%和45.5%,术后3年总体生存率分别为55.6%和39.4%,5年总体生存率分别为48.1%和36.4%,两组比较差异均无统计学意义(P>0.05)。结论SEMS置入序贯手术治疗梗阻性结直肠癌安全、可行,远期肿瘤学结果有效。Objective To compare the long-term oncologic outcomes of self-expanding metallic stents（ self-expanding metallic stents,SEMS） as a bridge to surgery（ SEMS group） with those of emergency surgery（ ES group） for malignant colorectal obstruction（ malignant colorectal obstruction,MCO）. Methods Adopting the method of retrospective study. The clinical data of 60 patients with MCO who accepted operation treatment were collected. Twenty-seven patients who underwent semi-elective curative resection after endoscopic SEMS insertion were included in the SEMS group,thirty-three patients who underwent emergency curative surgery were included in ES group. The clinic pathologic characteristics and overall survival（ overall survival,OS） were compared between the two groups. The multidisciplinary discussion and evaluation was given to all of all of these patients preoperative. Results There were no significant differences in general information,tumor stage,location,and histology between the SEMS group and the ES group. The median OS times were 37 months for the SEMS group and 23 months for the ES group. The proportions of patients who received postoperative adjuvant chemotherapy were comparable（ SEMS group vs.ES group,70. 4% vs. 45. 5%; P 0. 05）. The long-term oncologic outcome did not significantly different between two groups in the 3-year OS rate（ 55. 6% vs. 39. 4%; P 0. 05） and the 5-year OS rate（ 48. 1%vs. 36. 4%; P 0. 05）. Conclusion Long-term oncologic outcomes of SEMS insertion as a bridge to surgery for malignant colorectal obstruction is safe,effective and feasible.

关 键 词：支架 急诊外科 肠梗阻 结直肠癌 肿瘤学 

分 类 号：R735.34[医药卫生—肿瘤]