金属支架联合新辅助化疗在梗阻性结肠癌的疗效和安全性  

Curative effect and safety of metal stent combined with neoadjuvant chemotherapy in obstructive colon cancer

作　　者：谢德金[1] 孙晓丹[1] 张晓鹏[1] 王小忠[1] XIE De-Jin;SUN Xiao-Dan;ZHANG Xiao-Peng(Department of General Surgery,Shantou Central Hospital,Shantou 515031,Guangdong,Ghina)

机构地区：[1]汕头市中心医院,广东汕头515031

出　　处：《吉林医学》2025年第4期798-802,共5页Jilin Medical Journal

基　　金：汕头市科技计划医疗卫生类别项目[项目编号:201111166491177]。

摘　　要：目的:评价金属支架联合新辅助化疗在梗阻性结肠癌的疗效和安全性。方法:选取合并急性肠梗阻的60例结肠癌患者,患者置入肠道金属支架后,根据后续化疗方案不同分为对照组和试验组。对照组34例在梗阻解除后短期内行根治性手术,术后行常规辅助化疗;试验组26例先行4~6个周期新辅助化疗后再行手术,术后继续完成辅助化疗。比较两组支架并发症发生率(穿孔、出血、移位、脱落、堵塞、再狭窄等)、支架穿孔危险度、手术结果(手术时间、腹腔镜手术率、术中出血量、造口率等)和术后情况[术后住院时间、费用、并发症发生率、肿瘤退缩分级(TRG)、无瘤生存时间等]。结果:两组均未发生支架穿孔,两组支架并发症发生率差异无统计学意义(P>0.05),但试验组支架穿孔危险度显著低于对照组,差异有统计学意义(P<0.05);试验组手术时间、腹腔镜手术率、术中出血量和造口率均显著低于对照组,差异有统计学意义(P<0.05);两组住院费用差异无统计学意义(P>0.05),试验组住院时间、并发症发生率及TRG分级显著低于对照组,无瘤生存时间显著高于对照组,差异有统计学意义(P<0.05)。结论:对于具备新辅助化疗适应证的患者,植入金属支架不会增加支架穿孔的额外风险,具有较高安全性。术前进行新辅助化疗可有效杀灭肿瘤细胞,优化根治术手术条件,减少患者术后并发症,延长患者无瘤生存时间。Objective To evaluate the curative effect and safety of metal stent combined with neoadjuvant chemotherapy in obstructive colon cancer.Methods A total of 60 patients with colon cancer and acute intestinal obstruction in the First General Surgery Department of Shantou Central Hospital were enrolled between December 2020 and November 2022.According to different chemotherapy regiments after implantation of intestinal metal stents,patients were divided into a control group(34 cases,radical operation within a short time after obstruction disappearance+routine adjuvant chemotherapy)and an experimental group(26 cases,4-6 cycles of neoadjuvant chemotherapy+surgery+adjuvant chemotherapy).The incidence of stent complications(perforation,bleeding,displacement,shedding,blockage,restenosis),risk of stent perforation,surgical outcomes(operation time,laparoscopy rate,intraoperative blood loss,story rate),and postoperative situations〔length of hospital stay,cost,incidence of complications,tumor regression grading(TRG),tumor-free survival〕were compared between the two groups.Results There was no stent perforation in either group,there was no difference in the incidence of stent complications between the two groups(P>0.05),and the risk of stent perforation in the experimental group was lower than that in the control group(P<0.05).The operation time,laparoscopy rate,intraoperative blood loss,and stormy rate in the experimental group were lower than those in the control group(P<0.05).There was no significant difference in hospitalization cost between the two groups(P>0.05).The length of hospital stay,the incidence of complications,and TRG in the experimental group were lower than those in the control group,and tumor-free survival was longer than that in the control group(P<0.05).Conclusions For patients with neoadjuvant chemotherapy indications,metal stent implantation will not increase the additional risk of stent perforation,with high safety.Preoperative neoadjuvant chemotherapy can effectively kill tumor cells,optimize the co

关 键 词：结肠癌 肠梗阻 新辅助化疗 支架 

分 类 号：R735.35[医药卫生—肿瘤]