肠造口后择期手术对比支架置入后择期手术治疗梗阻性左半结肠癌的效果分析  

Decompressing stoma versus stent placement as bridge to surgery for left-sided obstructive colon cancer

作　　者：曾维根 韩加刚[1] 庞国义[1] 赵琦[1] 赵宝成[1] 王振军[1] Zeng Weigen;Han Jiagang;Pang Guoyi;Zhao Qi;Zhao Baocheng;Wang Zhenjun(Department of General Surgery,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院普外科,100020

出　　处：《中华结直肠疾病电子杂志》2021年第4期362-366,共5页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：首都卫生发展科研专项(No.首发2018-1-2032)。

摘　　要：目的比较肠造口和肠道支架解除左半结肠癌肠梗阻后择期手术的治疗效果。方法回顾性分析北京朝阳医院2002年1月至2018年12月收治的156例左半结肠癌肠梗阻患者的临床资料,肠造口组有70例患者,支架组有86例患者,比较两组患者的短期疗效和长期预后。结果肠造口组平均肿瘤直径更大(t=2.679,P<0.05),肿瘤更多位于结肠脾曲(χ^(2)=12.031,P<0.05)。两组患者年龄、性别、体重指数、肿瘤分期差异均无统计学意义(均P>0.05)。造口组手术时间长于支架组(t=3.276,P<0.05),肿瘤切除后肠造口率更高(χ^(2)=10.309,P<0.05)。两组患者术中出血量、腹腔镜手术比例、术后并发症发生率、围手术期死亡率、永久造口率差异均无统计学意义(均P>0.05)。支架组有更多患者出现局部复发(23.3%vs.8.6%,χ^(2)=5.991;P=0.014),5年无病生存率(45.7%vs 74.7%,χ^(2)=6.851;P=0.009)和总生存率(67.2%vs.79.4%,χ^(2)=4.900;P=0.027)均低于造口组。结论尽管支架组短期效果优于肠造口组,但是肠道支架可能影响肿瘤预后,需要随机对照研究进一步证实。Objective To compare the operative and oncological results of decompressing stoma and stent as a bridge to surgery for the curative treatment of obstructive left-sided colonic cancer.Methods A total of 156 consecutive patients with obstructive left-sided colonic cancer in the period January 2002 to December 2018 from Beijing Chao-yang Hospital who underwent radical resection with curative intent were retrospectively reviewed.Patients were divided into two groups:stoma group(n=70)and stent group(n=86).The short-and long-term outcomes between the groups were compared.Results The tumor size was larger(t=2.679,P<0.05)and more tumors located at splenic flexure in the stoma group(χ^(2)=12.031,P<0.05).Both groups had similar demographic and tumor characteristics in terms of age,gender,body mass index,and tumor stage(all P>0.05).The mean operating time was longer(t=3.276,P<0.05)and postresection stomas were more often in the stoma group(χ^(2)=10.309,P<0.05).The following terms were similar between two groups,including blood loss,the rate of laparoscopic surgery,overall postoperative complication rate,peri-operative mortality,permanent colostomy rate(all P>0.05).More patients in the stent group had local recurrence during follow-up(23.3%vs.8.6%,χ^(2)=5.991;P=0.014).The 5-year disease-free survival(45.7%vs 74.7%,χ^(2)=6.851;P=0.009)and overall survival(67.2%vs.79.4%,χ^(2)=4.900;P=0.027)were significantly lower in the stent group.Conclusions Although endoscopic stenting is associated with better surgical outcomes than decompressing stoma,it may negatively impact oncologic results.A randomized clinical trial that compares the two bridging techniques is needed.

关 键 词：结肠肿瘤 肠梗阻 自膨胀支架 结肠造口术 预后 

分 类 号：R735.35[医药卫生—肿瘤]