可扩张支架置入联合新辅助化疗后行择期左半结肠根治术治疗梗阻性左半结肠癌  

Selective left hemicolectomy after expandable stent placement to relieve obstruction combined with neoadjuvant chemotherapy in the treatment of obstructive left colon cancer

作　　者：程思俊 杨驭媒[2] 袁波[1] 卢建利 邓超[4] Cheng Sijun;Yang Yumei;Yuan Bo;Lu Jianli;Deng Chao(Gastrointestinal Surgery,Shahe Hospital,Chengdu Sixth People’s Hospital Chengdu,sichuan 610051,China;Clinical Laboratory of Chengdu Sixth People’s Hospital Chengdu,sichuan 610051,China;Department of Hepatobiliary and pancreatic Surgery,363 Hospital Chengdu,sichuan 610041,China;General Surgery Department,Zigong First People’s Hospital Sichuan zigong 643000,China)

机构地区：[1]成都市第六人民医院沙河院区胃肠外科,成都610051 [2]成都市第六人民医院沙河院区检验科,成都610051 [3]三六三医院肝胆胰外科,成都610041 [4]自贡市第一人民医院普外科,四川自贡643000

出　　处：《中华普外科手术学杂志（电子版）》2021年第4期430-433,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：四川省卫生健康委员会科研课题-重点研究项目(19ZD032);四川省科学技术厅应用基础项目(2019YJ0133)。

摘　　要：目的研究梗阻性左半结肠癌患者可扩张支架置入解除梗阻联合新辅助化疗(NC)后择期行左半结肠根治术的临床疗效。方法选取2018年1月至2019年3月两家医院治疗的梗阻性左半结肠癌患者70例,根据治疗方法不同分为两组,各35例。联合组患者在数字减影造影(DSA)引导下可扩张支架置入解除梗阻同期联合NC治疗后择期行左半结肠根治术,对照组患者不做NC治疗,其余治疗相同。采用软件SPSS23.0进行统计学分析。围术期指标等计量资料采用(x±s)表示,行独立t检验;并发症等计数资料采用χ^(2)检验,P<0.05表示差异有统计学意义。结果两组患者支架置入并发症总发生率比较差异无统计学意义(14.3%vs.20.0%,P=0.526),联合组患者新辅助化疗毒副反应轻,符合手术指征。联合组患者手术时间、术中出血量、术中造口数量、术后引流量、首次排便/进食时间、术后住院时间及术后并发症均显著优于对照组,组间差异有统计学意义(P<0.05)。结论DSA引导下可扩张支架置入术联合NC后择期行左半结肠根治术治疗梗阻性左半结肠癌,具有缩短手术时间、降低造口率和并发症发生率,有利于患者术后康复。Objective To study the clinical effect of selective radical resection of left colon in patients with obstructive left colon cancer after the removal of obstruction by dilatable stent implantation combined with neoadjuvant chemotherapy(NC).Methods A total of 70 patients with obstructive left colon cancer treated in two hospitals from January 2018 to March 2019 were selected.According to different treatment methods,the patients were divided into two groups with 50 cases each.Under the guidance of digital subtraction angiography(DSA),patients in the combined group were treated with dilated stent to relieve obstruction.After the concurrent NC treatment,the left semicolon was selected for radical resection.Patients in the control group did not receive NC treatment,and other treatments were the same.SPSS23.0 software was used for statistical analysis.Measurement data such as perioperative indicators were represented by (x±s),and independent t test was performed.The data of complications were tested byχ^(2) test,and P<0.05 indicated a statistically significant difference.Results There was no statistically significant difference in the total incidence of stent implantation complications between the two groups(14.3%vs.20.0%,P=0.526),and the toxic and side effects of neoadjuvant chemotherapy were mild in the combined group,consistent with the indications of surgery.The operative time,intraoperative blood loss,intraoperative stoma number,postoperative drainage volume,time of first defecation/feeding,postoperative hospital stay and postoperative complications of the combined group were significantly better than those of the control group,and the differences between the two groups were statistically significant(P<0.05).Conclusion Under the guidance of DSA,expansive stent implantation combined with neoadjuvant chemotherapy can be performed at an optional time for the treatment of obstructed left colon cancer,which can shorten the operation time,reduce the rate of stoma and complications,and is conducive to the postoperative

关 键 词：结肠肿瘤 支架 新辅助化疗 血管造影术 数字减影 

分 类 号：R735.35[医药卫生—肿瘤]