自膨胀金属支架在左侧大肠癌伴急性梗阻中的应用价值  

Application value of self-expandable metal stent in patients of left-side colorectal cancer with acute obstruction

作　　者：张守亮 谢黎 姚俊 ZHANG Shou-liang;XIE Li;YAO Jun(Department of Gastrointestinal Surgery 1.Department of Gastroenterology;Zhenfiang First People＇s Hospital,Zhenjiang 212000,Jiangsu,CHINA)

机构地区：[1]镇江市第一人民医院胃肠外科,江苏镇江212000 [2]镇江市第一人民医院消化内科,江苏镇江212000

出　　处：《海南医学》2018年第20期2859-2862,共4页Hainan Medical Journal

摘　　要：目的探讨内镜下植入自膨胀金属支架在左侧大肠癌伴急性梗阻患者中的应用价值。方法回顾性分析2016年3月至2018年6月镇江市第一人民医院胃肠外科收治的40例左侧大肠癌伴急性梗阻患者经内镜植入自膨胀金属支架的临床效果,其中18例未能手术,1例术中发现肠系膜转移结节仅行结节活检,21例完成肠癌切除。将21例支架植入后肠梗阻缓解、限期行肠癌根治性切除的患者作为支架+手术组,同时间段20例单纯行肠癌根治性切除的患者作为单纯手术组。比较两组患者的性别、年龄、肿瘤位置、肿瘤直径、手术方式、肠造口率、术中失血、pTNM分期、术后住院天数、总住院天数、并发症发生率和一期吻合率。结果支架+手术组和单纯手术组在性别、年龄、肿瘤位置、肿瘤直径、手术方式、pTNM分期、术后住院天数、总住院天数方面比较,差异均无统计学意义(P>0.05);与单纯手术组比,支架+手术组患者的肠造口率更低(9.5%vs 40.0%)、总并发症发生率更低(4.8%vs30.0%)、一期吻合率更高(90.5%vs 60.0%)、术中失血量更低[(38.6±18.2) mL vs (83.0±63.8) mL],差异均有统计学意义(P<0.05);而在未能手术的18例中,1例高龄患者因肠梗阻未缓解放弃进一步治疗,9例肝或和肺转移患者接受化疗,8例无转移患者接受化疗或中药治疗,梗阻缓解率为94.4%(17/18)。结论对于左侧大肠癌伴急性梗阻患者先行内镜下自膨胀金属支架植入,待梗阻缓解后再行肠癌根治性切除可减少肠造口率、总并发症发生率和术中失血量,增加一期吻合率,是一种安全可行的治疗方法。对于高龄、远处转移且拒绝手术的患者,支架植入作为姑息性治疗可缓解肠梗阻症状,改善生活质量。Objective To explore the application value of self-expandable metal stent implantation under endoscopy in patients of left-side colorectal cancer with acute obstruction. Methods The clinical therapeutic effect of 40 patients of malignant left-side colorectal cancer with obstruction who underwent self-expandable metal stent（SEMS） insertion in Department of Gastrointestinal Surgery of Zhenjiang First People＇s Hospital were retrospectively analyzed from March 2016 to June 2018. Among them, 18 cases did not received surgery, 1 case only underwent nodule biopsy because of mesenteric implant nodules, and 21 had colorectal cancer radical resection. The 21 patients undergoing stent implantation and radical resection were enrolled as the stent＋surgery group, and 20 patients receiving colorectal cancer radical resection only were included in teh simple surgery group in the same period. Patients in the two groups were compared for gender, age, tumor location, tumor diameter, surgical method, colostomy rate, intraoperative blood loss, pTNM stage, postoperative hospitalization days, total hospitalization days, complications rate and first-stage anastomosis rate.Results There was no statistically significant difference in gender, age, tumor location, tumor diameter, surgical method, pTNM stage, postoperative hospitalization days and total hospitalization days between the stent＋surgery group and the simple surgery group（P〈0.05）. Compared with the simple surgery group, the stent＋surgery group had significantly lower colostomy rate（9.5% vs 40.0%）, lower total complication rate（4.8% vs 30.0%）, higher first-stage anastomosis rate（90.5% vs 60.0%）, less intraoperative blood loss（38.6±18.2） vs（83.0±63.8）, with statistically significant differences（P〈0.05）. Among the 18 cases that did not underwent operation, 1 elderly patient gave up further treatment because ileus was not relieved, 9 cases were treated with adjuvant chemotherapy due to liver or/and lung metastasis, and 8 cases without liv

关 键 词：自膨胀金属支架 左侧大肠癌 急性梗阻 疗效 

分 类 号：R735.34[医药卫生—肿瘤]