经内镜支架植入术治疗左半结肠癌及直肠癌所致肠梗阻30例分析  

Analysis of 30 cases of endoscopic stent implantation for left-sided obstructive colon cancer

作　　者：徐媛 许涛 Xu Yuan;Xu Tao(Department of Critical Care Medicine,Wuhan Fourth Hospital,Wuhan 430030,China)

机构地区：[1]武汉市第四医院常青院区重症医学科,武汉430030

出　　处：《中华实验外科杂志》2024年第4期815-817,共3页Chinese Journal of Experimental Surgery

摘　　要：目的探讨肠道支架联合限期手术治疗左半结肠癌及直肠癌伴肠梗阻患者的临床有效性及安全性。方法分析2017年10月至2023年12月武汉市第四医院收治的左半结肠癌及直肠癌伴肠梗阻患者30例,根据治疗方式不同分为联合治疗组(试验组)(12例,先行肠道支架置入术后行腹腔镜或者开腹下一期切除吻合术)和单纯手术组(对照组)(18例,行急诊开腹手术)。收集患者临床资料,对两组患者一期吻合切除率、肠(结肠或回肠)造口率等手术相关指标、并发症等进行分析。结果两组患者在性别、年龄方面差异无统计学意义(P>0.05)。试验组一期切除吻合率高于对照组[10/12(83.3%)比5/18(27.8%),F=-8.593,P<0.01],肠造口率低于对照组[2/12(16.7%)比17/18(94.4%),F=18.131,P<0.01];两者在腹腔镜手术率方面差异无统计学意义[7/12(58.3%)比4/18(22.2%),F=3.908,P>0.05]。并发症方面,试验组肺部并发症低于对照组,差异有统计学意义[2/12(16.7%)比11/18(61.1%),F=5.599,P<0.05];两者在围手术期穿孔、切口并发症、造口并发症方面差异无统计学意义[1/12(8.3%)比1/18(5.6%),F=0.086,P>0.01;2/12(16.7%)比8/18(44.4%),F=2.417,P>0.235;0/12(0.0%)比3/18(16.7%),F=2.418,P>0.05]。结论肠道支架在左半结肠癌及直肠癌伴肠梗阻中的应用安全、有效,可以提高一期吻合率,降低造口率,降低并发症发生率。Objective To investigate the therapeutic effect of endoscopic implantation of metal stents for left-sided obstructive colon cancer.Methods The clinical data of 30 cases of left-sided obstructive colon cancer were retrospectively analyzed from October 2017 to December 2023.According to different surgical methods the patients were divided into study group(12 cases)and control group(18 cases).Patients in the study group received laparoscopic/open surgery after intestinal stent placement,and those in the control group received routine treatment.The therapeutic effect and complications of the two groups were compared.Results There was no significant difference in gender and age between the two groups(P>0.05).The anastomosis rate of primary resection in experimental group was higher than that in control group[10/12(83.3%)vs.5/18(27.8%),F=-8.593,P<0.01],and the enterostomy rate was lower than that in control group[2/12(16.7%)vs.17/18(94.4%),F=18.131,P<0.01].There was no significant difference in the rate of laparoscopic surgery between them[7/12(58.3%)vs.4/18(22.2%),F=3.908,P>0.05].In terms of complications,the pulmonary complications in the test group were lower than those in the control group,with statistical significance[2/12(16.7%)vs.11/18(61.1%),F=5.599,P<0.05].There was no significant difference between the two groups in perioperative perforation,incision complications and stomostomy complications[1/12(8.3%)vs.1/18(5.6%),F=0.086,P>0.05;2/12(16.7%)vs.8/18(44.4%),F=2.417,P>0.05;0/12(0.0%)vs.3/18(16.7%),F=2.418,P>0.05].Conclusion The clinical effect and safety of intestinal stent implantation combined with laparoscopic/open surgery can improve the primary anastomosis rate and reduce the stoma rate.

关 键 词：左半结肠肿瘤 直肠肿瘤 肠梗阻 肠道支架 

分 类 号：R735.3[医药卫生—肿瘤]