术前内镜支架置入联合新辅助化疗治疗梗阻性左半结肠癌疗效观察

Clinical observation of endoscopic stent implantation combined with neoadjuvant chemotherapy in the treatment of obstructive left hemicolon carcinoma

目的观察术前内镜支架置入联合新辅助化疗治疗梗阻性左半结肠癌的临床效果,为临床治疗提供参考依据。方法选取2016年3月至2018年6月期间阳江市人民医院收治的梗阻性左半结肠癌患者40例,应用数字随机法分为对照组和观察组,每组20例,对照组应用术前内镜支架置入,置入后进行手术治疗,观察组术前内镜支架置入联合新辅助化疗治疗,比较两组患者的手术方式、手术时间、术中失血量、术后排气时间、术后住院时间及并发症发生率。结果观察组患者的开放手术率为30.0%,腹腔镜手术率为70.0%,对照组行开放手术率为65.0%,腹腔镜手术率为35.0%,观察组患者开放手术率低于对照组,腹腔镜手术率高于对照组,差异均有统计学意义(P<0.05);观察组和对照组患者的术中失血量[(48.6±16.1)mL vs(126.3±40.2)mL]、手术时间[(146.4±45.7)min vs(178.2±57.3)min]、术后排气时间[(56.1±13.6)h vs(69.1±15.9)h]、术后住院时间[(8.4±2.5)d vs(13.6±10.1)d]比较,观察组患者均少于或短于对照组,差异均有统计学意义(P<0.05);观察组患者新辅助化疗期间出现恶心、呕吐等不良反应37例次,均为1度和2度,无3度严重化疗不良反应;观察组患者的并发症发生率为15.0%,明显低于对照组的25.0%,差异有统计学意义(P>0.05)。结论术前内镜支架置入联合新辅助化疗治疗梗阻性左半结肠癌可提高腹腔镜手术率,缩短手术时间,减少并发症发生率。

Objective To observe the clinical effect of preoperative endoscopic stent implantation combined with neoadjuvant chemotherapy in the treatment of obstructive left hemicolon carcinoma,and to provide a reference for future clinical treatment.Methods A total of 40 cases of patients with obstructive left colonic cancer,who admitted to the People's Hospital of Yangjiang City from March 2016 to June 2018,were selected and divided into the control group and observation group according to random number table method,with 20 cases in each group.The control group received preoperative endoscopic stent implantation and the surgical treatment was performed after stenting;the observation group underwent preoperative endoscopic stenting combined with neoadjuvant chemotherapy.The surgical procedure,operation time,intraoperative blood loss,postoperative exhaust time,postoperative hospital stay,and complications of the two groups were compared.Results The rates of open surgery and laparoscopic surgery in the observation group were 30.0%and 70.0%versus 65.0%and 35.0%in the control group(all P<0.05).The volume of intraoperative blood loss,operation time,postoperative exhaust time and postoperative hospital stay in the observation group were(48.6±16.1)mL,(146.4±45.7)min,(56.1±13.6)h,(8.4±2.5)d,respectively,which were significantly lower or shorter than corresponding(126.3±40.2)mL,(178.2±57.3)min,(69.1±15.9)h,(13.6±10.1)d in the control group(all P<0.05).In the observation group,nausea,vomiting and other adverse reactions occurred for 37 cases in 20 patients during neoadjuvant chemotherapy,all of which were degree 1 and degree 2,and no severe adverse reactions occurred in degree 3.The complication rate in the observation group was 15.0%,which was significantly lower than 25.0%in the control group(P>0.05).Conclusion Preoperative endoscopic stent implantation combined with neoadjuvant chemotherapy can improve the rate of laparoscopic surgery,shorten the operation time and reduce the incidence of complications in the treatment of obstructive left hemicolon carcinoma.