自膨胀金属支架在癌性肠梗阻治疗中的临床疗效分析

Clinical Efficacy of Self- expanding Metallic Stents in the Treatment of Colorectal Cancer Obstruction

背景结直肠癌是常见的肿瘤,部分患者就诊时已伴有急性完全或不完全性肠梗阻,急诊手术一直是肠梗阻治疗的首选方案,而自膨胀金属支架(SEMS)的运用,使急诊手术转变为择期手术,同时降低了术后并发症和病死率。目的比较行SEMS后序贯择期手术治疗与急诊手术治疗癌性肠梗阻患者的短期疗效,探讨SEMS在癌性肠梗阻中的有效性和安全性。方法回顾性分析2011年9月—2015年4月在哈尔滨医科大学附属第二医院结直肠肿瘤外科治疗的78例结直肠癌伴肠梗阻患者。根据治疗方式将患者分为急诊手术组54例,SEMS组24例。收集患者临床资料,观察患者一期吻合切除率、肠造口率、术中出血量、淋巴结清扫数目、手术时间、美国麻醉医师协会(ASA)分级、平均住院时间、术后排气时间、美国癌症联合委员会(AJCC)术后分期,观察患者术后并发症发生情况。结果两组患者性别、病理类型比较,差异有统计学意义(P<0.05)。两组患者年龄、体质指数(BMI)及糖尿病、高血压、心脏病、肝胆系统疾病、呼吸系统疾病发生率比较,差异无统计学意义(P>0.05)。SEMS组患者SEMS留置时间为(14.5±5.9)d。SEMS组患者手术时间短于急诊手术组,平均住院时间长于急诊手术组(P<0.05)。两组患者一期吻合切除率、肠造口率、术中出血量、淋巴结清扫数目、ASA分级、术后排气时间、AJCC术后分期比较,差异均无统计学意义(P>0.05)。两组患者术后并发症发生率比较,差异均无统计学意义(P>0.05)。结论 SEMS可安全、有效地应用于癌性肠梗阻的治疗,值得临床推广应用。

Background Colorectal cancer is one of the world＇s common tumor, and some patients are found to have acute complete or incomplete bowel obstruction when seeking for treatment. Emergency surgery is the first choice for the treatment of intestinal obstruction, since the use of self- expanding metallic stent （SEMS） could change the emergency surgery to elective surgery, and reduce the postoperative complications and mortality. Objective To evaluate the efficacy and safety of SEMS by comparing shortterm efficacy of elective surgery after stent insertion and emergency surgery on patients with obstructive colorectal cancer. Methods A retrospective analysis was made on the clinical data of 78 patients with obstructive colorectal cancer who received treatment in the Department of Colorectal Cancer Surgery of the Second Affiliated Hospital of Harbin Medical University from September 2011 to April 2015. According to treatment method, the patients were divided into two groups： emergency operation group （ n = 54） and SEMS group （ n = 24） . Clinical data of patients were collected, and the rate of one - stage resection and anastomosis, enterostomy rate, amount of bleeding during surgery, number of lymph gland dissection, operation time, ASA grading, average hospital stay, postoperative evacuation time and the postoperative staging of AJCC. The occurrence of complications after surgery was observed. Results The two groups were significantly different in gender and pathological types （P 〈 0. 05） . The two groups were not significantly different in age, BMI , diabetes mellitus, hypertension, cardiac disease, live and gall diseases and respiratory diseases （P 〉 0. 05 ） . The indwelling time of SEMS was （ 14. 5 ± 5.9） d for the SEMS group. The SEMS group had shorter operation time and longer average hospital stay than emergency operation group （P 〈 0. 05） . The two groups were not significantly different in the rate of one - stage resection and anastomosis, enterostomy rate, amount of bleeding during surgery, number of lymph gland dissection, ASA grading, postoperative evacuation time and the postoperative staging of AJCC （ P 〉 0.05 ） . The two groups were not significantly in the incidence of postoperative complications （P 〉 0.05） . Conclusion SEMS is safe and effective in the treatment of obstructive colorectal cancer, and is worth promotion in clinical practice.