应用自膨胀金属支架治疗梗阻性结直肠癌25例的疗效观察  

Clinical application of self-expandable metal stents in the preoperative management of acute obstructive colorectal cancer,report of 25 cases

作　　者：孙亮 崔伟[1] 何玉琦 袁强 杜峻峰 聂玉辉 东星 耿金璐 陈纲 李世拥 Sun Liang;Cui Wei;He Yuqi;Yuan Qiang;Du Junfeng;Nie Yuhui;Dong Xing;Geng Jinlu;Chen Gang;Li Shiyong(Department of General Surgery,the 7th Medical center of PLA General Hospital,Beijing 100700,China)

机构地区：[1]解放军总医院第七医学中心普通外科,北京100700

出　　处：《中华普外科手术学杂志（电子版）》2020年第5期468-471,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探讨肠镜下自膨胀金属支架(SEMS)置入序贯手术与急诊手术(ES)在梗阻性结直肠癌患者的治疗效果。方法回顾性分析2014年至2019年接受手术治疗的梗阻性结直肠癌患者55例,其中SEMS组25例,术前接受肠道支架置入,梗阻解除后1周左右行根治性切除;ES组30例接受急诊手术治疗。采用SPSS24.0统计软件处理和分析数据。术中术后各项指标采用(±s)表示,独立t检验;术后并发症、肿瘤根治性切除率等采用χ2检验。P<0.05为有统计学意义。结果原发肿瘤根治性切除:ES组22例(73.3%)明显低于SEMS组25例(100%);ES组切除淋巴结为(9.6±5.5)个明显低于SEMS组(18.7±7.7)个;一期手术造口:ES组26例(86.7%),SEMS组11例(44.0%);造口还纳率ES组38.4%,SEMS组90.9%;永久性造瘘率ES组16例(53.3%),SEMS组1例(4.0%);手术切口感染:ES组4例(13.3%),SEMS组0例(0.0%),上述各项指标两组差异均有统计学意义(P<0.05)。结论肠镜下放置SEMS,然后序贯手术治疗结直肠癌梗阻是安全、有效的备选治疗方案之一。Objective To investigate the curative effect of self-expandable metal stents(SEMS)in the preoperative management of acute obstructive colorectal cancer.Methods A retrospective analysis was performed in 55 patients with obstructive colorectal cancer who underwent surgery from 2014 to 2019,including 25 cases in the SEMS group received peroperative implantation of SEMS and underwent selective surgery 1 week later,while 30 cases in ES group received emergency surgery.Statistical analysis were performed by using SPSS24.0 software.Intraoperative and postoperative indexes were expressed as(±s),and were examined by using independent t test.Count data such as postoperative complications and radical resection rate of tumor were tested by usingχ2 test.A P value of<0.05 was considered as statistically significant difference.Results In terms of radical resection of the primary tumor,there were 22 patients(73.3%)in the ES group which were significantly lower than 25 patients(100%)in the SEMS group.In terms of harvested lymph nodes,there were(9.6±5.5)in the ES group which was significantly lower than(18.7±7.7)in the SEMS group.In terms of incidence of colostomy in primary surgery,there was 26 cases(86.7%)in the ES group and 11 cases(44.0%)in the SEMS group.The Colostomy closure rate was 38.4%in the ES group and 90.9%in the SEMS group.The permanent colostomy rate was 53.3%(16/30 cases)in the ES group and 4.0%in the SEMS group(1/25 cases).There were 4 cases(13.3%)of surgical incision infection in the ES group,while 0 cases(0.0%)in the SEMS group,with significant difference(P<0.05).Conclusion It is a safe and effective treatment to use SEMS as peroperative management of acute obstructive colorectal cancer.

关 键 词：结直肠肿瘤 肠梗阻 自膨胀金属支架 

分 类 号：R735.34[医药卫生—肿瘤]