不同术式治疗左侧结肠癌并发急性肠梗阻的临床效果及预后影响因素分析  

Clinical Efficacy and Prognostic Factor Analysis of Different Surgical Approaches in the Treatment of Left Colon Cancer Complicated with Acute Intestinal Obstruction

作　　者：向荣 文家治 XIANG Rong;WEN Jiazhi(Department of General Surgery,Hanzhong Hospital of Traditional Chinese Medicine,Hanzhong,Shaanxi 723100,China;Department of General Surgery,Chang'an Hospital in Xi'an,Xi'an 710018,China)

机构地区：[1]汉中市中医医院普通外科,陕西汉中723100 [2]西安市长安医院普通外科,西安710018

出　　处：《临床误诊误治》2024年第15期25-29,共5页Clinical Misdiagnosis & Mistherapy

基　　金：西安市科技计划项目(2022JH-YBYJ-0369)。

摘　　要：目的对比2种手术方式治疗左侧结肠癌并发急性肠梗阻的临床效果并分析患者预后影响因素。方法回顾性分析2020年1月至2023年1月收治的102例左侧结肠癌并发急性肠梗阻患者的临床资料,按治疗方法分为对照组和观察组,每组51例。对照组行左半结肠Ⅰ期切除吻合近端造瘘术,观察组行左半结肠Ⅰ期根治性肠切除吻合术。记录2组患者手术时间、术中出血量、胃管拔除时间、住院时间及术后首次进食、排气、排便时间。记录2组患者随访期间切口出血、切口感染、腹腔感染、吻合口瘘等并发症的发生情况。采用多因素COX回归分析影响左侧结肠癌并发急性肠梗阻患者术后预后的影响因素。结果观察组手术时间短于对照组,术中出血量少于对照组,但胃管拔除时间、首次进食时间、首次排气时间及首次排便时间长于对照组(P<0.01)。2组患者术后并发症总发生率比较差异无统计学意义[58.82%(30/51)vs 52.94%(27/51)](P>0.05)。102例总生存率为91.18%(93/102)。多因素COX回归分析显示:病理类型、TNM分期、术后辅助化疗、手术方式是影响左侧结肠癌并发急性肠梗阻患者预后的危险因素(P<0.05,P<0.01)。结论Ⅰ期根治性肠切除吻合术治疗左侧结肠癌并发急性肠梗阻患者较Ⅰ期切除吻合近端造瘘术具有良好的临床效果,但全身状况不佳或高危患者可采取Ⅰ期切除吻合近端造瘘术,以降低吻合口瘘和术后并发症的发生风险。Objective To compare clinical effects of two different surgical approaches in the treatment of left colon cancer complicated with acute intestinal obstruction(AIO),and to analyze the prognostic factors.Methods Clinical data of 102 patients with left colon cancer complicated with AIO admitted to the hospital from January 2020 to January 2023 were retrospectively analyzed.According to treatment methods,they were divided into control group and observation group,with 51 patients in each group.The control group underwent stageⅠresection and anastomosis of the left colon and proximal colostomy,and the observation group underwent stageⅠradical resection and anastomosis of the left colon.Duration of operation,intraoperative blood loss,time of gastric tube removal,length of hospital stay,time to first postoperative food intake,first anal exhaust time and defecation time were recorded in the two groups.The occurrence of complications such as incision bleeding,incision infection,abdominal infection and anastomotic fistula were recorded in the two groups during follow-up.Multivariate COX regression analysis was used to investigate the influencing factors of postoperative prognosis in patients with left colon cancer complicated with AIO.Results The duration of operation was shorter and intraoperative blood loss was less in the observation group than in the control group,but the time of gastric tube removal,time to first postoperative food intake,the first anal exhaust time and the first defecation time were longer than those in the control group(P<0.01).There was no significant difference in the total incidence of postoperative complications between the two groups[58.82%(30/51)vs.52.94%(27/51)](P>0.05).The overall survival of 102 patients was 91.18%(93/102)at 1-year follow-up.Multivariate COX regression analysis showed that pathological type,TNM stage,postoperative adjuvant chemotherapy and surgical approach were the risk factors affecting the prognosis of patients with left colon cancer complicated with AIO(P<0.05,P<0.01

关 键 词：结肠肿瘤 肠梗阻 肠吻合术 吻合近端造瘘术 手术后并发症 肿瘤分期 预后 

分 类 号：R735.35[医药卫生—肿瘤]