内镜下大肠支架置入术在老年结直肠癌并急性肠梗阻患者中的应用

Clinical value of endoscopic metal stent placement for malignant colonic obstruction in aged people

目的 探讨内镜下大肠支架置人在老年人结直肠癌并急性肠梗阻的临床应用价值。方法65岁以上结直肠癌并急性肠梗阻患者82例，分为大肠支架组41例，行Niti-S肠道支架置人；以及急诊手术组41例，根据术中探查结果分别行肿瘤切除及结肠造瘘。比较两组的平均住院日，平均住院费用，中位生存时间，1年生存率，围手术期病死率，手术并发症等情况。结果 大肠支架组平均住院日（17．9±6．7）d，平均住院费用40047元，中位生存时间（9．4±4．4）个月，1年生存率43．9％。急诊手术组平均住院日（24．4±4．6）d，平均住院费用61867元，中位生存时间（8．8±4．8）个月，1年生存率36．6％。结论大肠内支架对于结直肠癌合并肠梗阻的老年患者是一种安全、经济、有效的治疗方式。

Objective To evaluate the clinical value of endoscopic placement of colorectal metal stents for malignant colonic obstruction in aged patients. Methods The 82 cases who were older than 65 years with malignant colonic obstruction were randomly divided into colorectal metal stenting group who were treated with endoscopic Niti S colorectal metal stenting and emergency surgery group who were treated with tumor resection or colostomy. The average length of stay, average hospilalization charge, median survival time, one-year survival rate, perioperative mortality, and the complications such as anastomotic leakage, incision infection were analyzed. Results In coloreetal metal stenting group, in 39 of 41 patients, metal stents were successfully inserted, without complications of hemorrhage, perforation and so on. And the symptoms of obstruction were effectively relieved within 2 days. The 17 cases underwent subsequent elective radical resection of colorectal carcinoma after 1 week, without complications of anastomotic leakage. The 22 cases were treated with colorectal metal stenting for palliative treatment. There were 4 cases of stent migration and 5 cases of stent obstruction again. The average length of inhospital stay was （17.9 ± 6.7） days, the average hospitalization charge was 40 047 yuan, the median survival time was （9.4 ± 4.4） months, and one- year surviwd rate was 43.9%. In emergency surgery group, 13 cases underwent tumor resection and 28 cases received colostomy. The 14 cases presented with multiple organ dysfunction, 8 cases died preoperatively, 4 cases presented with anastigmatic leakage. The average length of stay was （24.4 ± 4.6） day, the average hospitalization charge was 61 867 yuan, the median survival time was （8.8 ± 4.8） months, and one year survival rate was 36.6%. Conclusions Endoscopic colorectal metal stenting is a safe, economic and effective treatment for malignant colonic obstruction in aged patients, especially reduces the risk of surgical complications, improves the aged patient＇s quality of life.