手术时机对结肠癌致急性肠梗阻患者预后的影响分析

Effect of operative timing on prognosis of patients with acute intestinal obstruction caused by colon cancer

目的分析支架置入后择期手术与急诊手术对结肠癌致急性肠梗阻患者预后的影响。方法 90例结肠癌致急性肠梗阻患者中,支架置入后,45例于3~5 d择期行腹腔镜结肠癌根治术,另45例于48 h内行Ⅰ期根治性结肠癌切除吻合术急诊手术,分别为择期组和急诊组,比较两组手术治疗近期效果和术后生存率。结果择期组手术时间、肛门排气时间、术后住院时间均显著短于急诊组,切口长度显著小于急诊组,清扫淋巴结数量明显多于急诊组(P<0.05),切口感染、腹腔内感染、吻合口瘘发生率明显低于急诊组(P<0.05)。择期组术后1年生存率为91.11%,较急诊组的80.00%略高,但差异无统计学意义(P>0.05);而其术后2年生存率为64.44%,显著高于急诊组的42.22%(P<0.05)。结论支架置入后择期行腹腔镜结肠癌根治术可取得更理想的手术效果,并发症少,对提高患者术后生存率及改善预后有重要意义。

Objective To analyze the effects of elective operation and emergency operation after stent placement on the prognosis of patients with acute intestinal obstruction caused by colon cancer. Methods Among 90 patients with acute intestinal obstruction caused by colon cancer, after stent implantation, 45 ones underwent laparoscopic radical resection for colon cancer at 3 ～5 d（ ＂the elective group＂）, and another 45 ones underwent primary radical resection and anastomosis operation within 48 h（ ＂the emergency group＂）, respectively. The operative effects and postoperative survival rates between the two groups were compared. Results The operation time, anus exhaust time and postoperative hospitalization time in the elective group were significantly shorter than those in the emergency group. The length of incision was significantly smaller than that in the emergency group, and the lymph nodes was significantly more than those in the emergency group（P〈0.05）; the incidence of incision infection, intraperitoneal infection and anastomotic fistula was significantly lower than that in the emergency group（P〈0.05）. The one-year survival rate of the elective group was 91.11%, which was slightly higher than that of the emergency group（80.00%）, but the difference was not statistically significant（P〈0.05）, and the two-year survival rate was 64.44%, significantly higher than that in the emergency group（42.22%）（P〈0.05）. Conclusion Laparoscopic radical resection for colon cancer after stent implantation has preferable operation effects, and there will be fewer complications. It is of great significance to improve the postoperative survival rate and the prognosis of the patients.