内镜下支架置入结合择期手术与急诊手术治疗梗阻性结直肠癌临床研究

Clinical study of endoscopic stent placement combined with elective surgery and emergency surgery for obstructive colorectal cancer

目的探讨内镜下支架置入联合择期手术与急诊手术治疗梗阻性结直肠癌的临床价值。方法回顾性分析2013年7月至2017年7月武汉市黄陂区中医医院外一科收治的66例梗阻性结直肠癌患者的临床资料,根据资料中不同的治疗方法将其分为对照组和观察组,每组33例,观察组予以内镜下支架置入联合择期手术治疗,对照组予以急诊手术治疗,比较两组患者一期切除吻合率、住院时间、手术时间、术后通气时间、并发症和住院期间死亡情况。结果观察组患者的一期切除吻合率为96.97%,明显高于对照组的57.58%,差异有统计学意义(P<0.05);观察组患者的手术时间和术后通气时间分别为(156.02±49.68) min、(3.58±1.38) d,均较对照组的(180.42±48.06) min、(4.50±2.07) d明显缩短,差异均有统计学意义(P<0.05);观察组患者的总并发症发生率为6.06%,明显低于对照组的30.30%,差异有统计学意义(P<0.05)。结论内镜下支架置入联合择期手术治疗梗阻性结直肠癌患者可使一期切除吻合率显著提高,迅速缓解肠梗阻症状,减少并发症。

Objective To investigate the clinical value of endoscopic stent implantation combined with elective surgery and emergency operation in the treatment of patients with obstructive colorectal cancer. Methods The clinical data of 66 cases of patients with obstructive colorectal cancer, who admitted to the First Department of Surgery, the Chinese Medicine Hospital of Huangpi District of Wuhan from July 2013 to July 2017, were retrospectively analyzed.According to the different treatment methods, the cases were divided into the control group and the study group with 33 cases in each group. The study group was treated with stent implantation combined with endoscopic surgery, and the control group received emergency surgical treatment. The one stage resection rate, hospitalization time, operation time,postoperative ventilation time, complications during hospitalization, and death were compared between the two groups Results(1) the rate of one-stage resection and anastomosis in the study group(96.97%) was significantly higher than that in the control group(57.58%), P<0.05;(2) the operation time and postoperative ventilation time in the study group were(156.02±49.68) min,(3.58±1.38) d, respectively, which were significantly shorter than corresponding(180.42±48.06) min and(4.50±2.07) d in the control group(P<0.05);(3) the complication rate of study group(6.06%)was significantly lower than that in the control group(30.30%), P<0.05. Conclusion Endoscopic stent placement combined with elective surgery for obstructive colorectal cancer can significantly improve the one-stage resection and anastomosis rate, relieve symptoms of intestinal obstruction and reduce complications.