金属支架和腹腔镜在结直肠癌伴梗阻治疗中的应用价值

Applied value of metallic stent combined with laparoscope on elder patients with intestinal obstruction caused by colorectal cancer

目的 研究联合金属支架与腹腔镜手术在治疗结直肠癌伴梗阻治疗中的疗效.方法 将2012年3月至2015年3月期间收治的48例高龄结直肠癌伴梗阻病人分为两组,①观察组：24例结直肠癌伴梗阻病人,植入金属支架缓解梗阻作为过渡治疗,完善相关术前准备,之后在腹腔镜下行结直肠癌根治性切除术;②对照组：24例结直肠癌伴梗阻的同期病人直接采取腹腔镜下结直肠癌切除术.结果 ①采取过渡性植入金属支架后进行根治性手术的病人24例,其中21例施行根治性切除,2例因转移至肝脏和肺未能切除,另1例因房颤未行金属支架置入术和腹腔镜结直肠癌切除术.术后随访24例,随访时间12～29个月,平均21个月.其中施行根治性切21例均无复发和转移,3例未能切除者死于肿瘤远处转移.对照组：24例采取直接腹腔镜手术治疗,24例行根治性手术,2例因术后肠瘘、多器官功能衰竭死亡,1例因术后发生胃转移死亡.随访：24例,随访时间10～24个月,平均15个月,对比两组病人,发现病人在支架置入后行腹腔镜根治术,术后并发症及生活质量有显著改善,生存时间并无明显差异.结论 相比直接采取腹腔镜手术切除的病人,联合金属支架植入与腹腔镜手术治疗方式具有安全、术后并发症少等优点,可提高病人生存质量,两组病人在生存时间上无明显差异.

Objective To study the effectiveness of the laparoscope combined with metallic stents in elder patients with intestinal obstruction caused by colorectal cancer. Methods Fifty-four eld- er patients were selected from Mar. 2012 to Mar. 2015 in Renmim Hospital of Wuhan University, and divided into two groups randomly： group A, receiving the metallic stents as the temporary treatment to release, thereafter, the laparoscopic resection was performed with coplete preoperative check; group B, receiving laparoscopic resection directly. Results Of 24 in group A, 21 were given radical re- section~ radical resection was not completed due to the distant metastases in the liver and lung in 2 ca- ses; and radical resection was not given due to atrial fibrillation in one case. All cases were followed up postoperatively for 12-29 months （average 21 months）. There were no recurrence and metastasis in 21 patients undergoing radical resection, and 3 cases without given surgical resection died of distant me- tastasis. In group B, 2 cases died of intestinal fistula-induced multiple organ failure, and metastasis of stomach occurred in one case after surgery. All 24 cases were followed up for 10-24 months （mean 15 months） The incidence of postoperative complications was lowered, the life quality was improved, and the survival time was prolonged in group A as compared with group B, but there was no significant difference in the survival time between two groups. Conclusions In comparison with the direct resec- tion of the colorectal cancer, the treatment of the metallic stent combined with laparoscopic surgery issafer and has less complications, and can increase the quality of life.