经鼻肠梗阻导管治疗不可切除结直肠癌腹膜转移所致肠梗阻的疗效及预后分析  

Outcomes and prognosis of long intestinal tube for malignant bowel obstruction caused by unresectable peritoneal metastases of colorectal cancer

作　　者：刘洋 彭焘 万源 吴可通 赖海洋 李丹[1] 梁锦汉 张波[1] Liu Yang;Peng Tao;Wan Yuan;Wu Ketong;Lai Haiyang;Li Dan;Liang Jinhan;Zhang Bo(Department of Interventional Center,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangdong Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院介入中心,广东广州510655

出　　处：《中华介入放射学电子杂志》2021年第4期388-394,共7页Chinese Journal of Interventional Radiology：electronic edition

摘　　要：目的探讨经鼻肠梗阻导管治疗不可切除结直肠癌腹膜转移所致肠梗阻的疗效及预后分析。方法采用回顾性研究方法,收集2018年4月至2020年12月我院收治的102例患者临床病例资料,分析经鼻肠梗阻导管置入术后肠梗阻症状缓解率,同时采用Kaplan-Meier法进行生存分析,采用Cox回归分析筛选独立预后危险因素。结果102例患者中男性74例,女性28例,中位年龄51.5岁。患者整体肠梗阻缓解率为74.5%(76/102),术后接受化疗或者化疗联合靶向治疗为45%(45/102),术后接受减瘤手术为4.9%(5/102)。截至2021年8月末次随访,中位总生存时间为2.8(95%CI:1.7~3.8)个月,6个月和1年的总体生存率分别为30%和12%。多因素分析显示:肠梗阻症状缓解(HR=0.548,95%CI:0.313~0.959,P=0.035)及术后化疗(HR=0.481,95%CI:0.284~0.815,P=0.007)显著降低患者死亡风险。结论对于不可切除结直肠癌腹膜转移所致的肠梗阻,经鼻肠梗阻导管置入能够明显改善患者的梗阻症状,并为后续系统化疗甚至减瘤手术创造条件,且安全性高,值得临床推广应用。Objective TTo explore the efficacy and prognosis of long intestinal tube treatment for malignant bowel obstruction(MBO)caused by unresectable peritoneal metastasis of colorectal cancer(mCRC).Methods A retrospective study was conducted.In accordance with the above criteria,clinicopathological data of 102 patients undergoing long intestinal tube at The Sixth Affiliated Hospital of Sun Yat-sen University,from April 2018 to December 2020 were retrospectively collected.The remission rates of obstruction after long intestinal tube were analyzed.Kaplan-Meier method was used to evaluate survival and Cox regression analysis was used to identify prognostic factors.Results Among 102 patients,74 were male and 28 were female with median age of 51.5(16~86)years.The remission rate of obstruction was 74.5%(76/102).Forty-five percent(45/102)patients underwent chemotherapy with or without targeting therapy,including 4.9%(5/102)cases scheduled for cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC).Till the last follow up of August 2021,the median overall survival time was 2.8(95%CI:1.7~3.8)months,and the 6-month and 1-year survival rates were 30%and 12%respectively.Multivariate analysis showed remission rate of obstruction(HR=0.548,95%CI:0.313~0.959,P=0.035)and chemotherapy with or without targeting therapy(HR=0.481,95%CI:0.284~0.815,P=0.007)were independent risk factors associated with prognosis of patients with MBO caused by unresectable peritoneal mCRC.Conclusions For patients with MBO caused by unresectable peritoneal mCRC,long intestinal tube may achieve higher symptom relief rate and prolong survival,and improve conditions for systematic chemotherapy,even CRS and HIPEC.

关 键 词：肠梗阻导管 不可切除结直肠癌腹膜转移 肠梗阻 

分 类 号：R735.34[医药卫生—肿瘤]