梗阻性左半结肠癌的治疗现状与争议

Current status and controversy in the treatment of obstructive left colon cancer

结直肠癌是常见的消化系统恶性肿瘤。结直肠癌合并梗阻的概率达20%,其中有70%发生在左半结肠。针对梗阻性左半结肠癌的治疗目前未达成共识。面对恶性梗阻患者,临床通常选择紧急手术或者自体膨胀性金属支架植入后择期手术。紧急手术可及时切除肿瘤,但是却带来高死亡率和并发症率;金属支架植入极大降低了危险并发症的概率,但是对远期预后的改善并没有明显提高。而选择手术时又面临分期手术还是一期肠切除吻合术的抉择,分期手术患者花费高,一期肠切除吻合术吻合口瘘风险高。如何选择最有利于患者的治疗方式取决于外科医生的临床决策能力,同时也需要开展更多的多中心临床研究。本文就梗阻性左半结肠癌的治疗现状与争议进行综述。

Colorectal cancer is a common malignant tumor of the digestive system.The incidence of colorectal cancer with obstruction is up to 20%,and 70%of such cases occur in the left colon.There is still no consensus on the treatment of obstructive left colon cancer.In patients with malignant obstruction,emergency or elective surgery is usually performed after implantation of autologous expandable metal stents.Tumor removal as an emergency procedure has high mortality and complication rates.Metal stent implantation greatly reduces the incidence of dangerous complications,but the long-term prognosis is not significantly improved.The surgical options available are staged surgery and one-stage intestinal resection and anastomosis.Staged surgery is expensive,while one-stage intestinal resection and anastomosis has a high risk of leakage.Choosing the most beneficial treatment for patients tests the clinical ability of surgeons,and more multi-center clinical research is needed.This article will review the current status and controversies in the treatment of obstructive left colon cancer.