自膨胀金属支架在结直肠癌梗阻中的应用研究  

Study on the application of self-expanding metallic stent in malignant colorectal obstruction

作　　者：汲广岩[1] 谢杨 胡登华[1] 魏正强[1] JI Guangyan;XIE Yang;HU Denghua;WEI Zhengqiang(Department of Gastrointestinal Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of General Surgery/Gastrointestinal Surgery,People′s Hospital of Chongqing Ba′nan District,Chongqing 401320,China)

机构地区：[1]重庆医科大学附属第一医院胃肠外科,400016 [2]重庆市巴南区人民医院普外科/胃肠外科,401320

出　　处：《重庆医学》2021年第4期621-625,共5页Chongqing medicine

基　　金：重庆市重点疾病防治技术攻关课题(2019ZX003)。

摘　　要：目的评估自膨胀金属支架(SEMS)置入术治疗结直肠癌肠梗阻的安全性和有效性。方法回顾性分析2015年1月至2018年12月于重庆医科大学附属第一医院行SEMS与行急诊手术(ES)治疗的结直肠癌梗阻患者的短期临床结果,比较两种治疗方式的疗效差异。结果与ES组比较,SEMS组升结肠梗阻明显减少(26.8%vs.0),支架置入至外科手术平均时间缩短为(13.64±7.12)d,术后清蛋白水平更高[(22.7±4.8)g/L vs.(26.2±5.1)g/L],腹腔镜手术比例更高(0 vs.85.7%),术中出血更少[(142.3±106.4)mL vs.(60.3±47.8)mL],一期吻合率更高(28.6%vs.82.1%),永久造口率更低(51.8%vs.17.9%),术后ICU入住率更低(64.3%vs.21.4%),术后肺部感染发生率(28.6%vs.3.6%)和凝血功能障碍发生率更低(16.1%vs.0),总住院天数更多[(14.8±8.1)d vs.(23.1±15.0)d],差异有统计学意义(P<0.05)。结论在结直肠癌合并梗阻的治疗中,非升结肠癌患者应用SEMS安全有效可行。Objective The aim of this study was to evaluate the safety and feasibility of self-expanding metallic stent(SEMS)implantation in the treatment of malignant colorectal obstruction.Methods The short-term clinical results of patients with malignant intestinal obstruction who underwent SEMS implantation or emergency surgery(ES)from January 2015 to December 2018 were retrospectively analyzed and the differences of curative effect between the two methods were compared.Results Compared with the ES group,ascending colon obstruction in the SEMS group was significantly reduced(26.8%vs.0),the average time from stent implantation to surgery was shortened to(13.64±7.12)d,the postoperative albumin level was higher[(22.7±4.8)g/L vs.(26.2±5.1)g/L],the proportion of laparoscopic surgery was higher(0 vs.85.7%),intraoperative bleeding was less[(142.3±106.4)mL vs.(60.3±47.8)mL],the first-stage anastomosis rate was higher(28.6%vs.82.1%),the permanent stoma rate was lower(51.8%vs.17.9%),the postoperative ICU occupancy rate was lower(64.3%vs.21.4%),the incidence of postoperative lung infection(28.6%vs.3.6%)and the incidence of coagulation dysfunction(16.1%vs.0)were lower,and the total hospital stay was more[(14.8±8.1)d vs.(23.1±15.0)d],the difference was statistical significance(P<0.05).Conclusion In the treatment of colorectal cancer with obstruction,SEMS is safe,effective and feasible for non-ascending colon carcinoma.

关 键 词：自胀式金属内支架 结直肠肿瘤 肠梗阻 消化系统外科手术 治疗结果 

分 类 号：R605[医药卫生—外科学]