支架联合腹腔镜治疗对结直肠癌伴梗阻患者预后的影响

The effect of stent combined with laparoscopic surgery on prognosis of colorectal cancer patients with obstruction

目的探讨支架联合腹腔镜治疗对结直肠癌伴梗阻患者预后的影响。方法选取2009年1月-2013年1月台州医院收治的98例结直肠癌伴梗阻患者,根据手术方式不同分为支架组49例(先行肠内支架置入,后行腹腔镜一期吻合术),对照组49例,采用传统急诊开腹手术。对比分析2组的造口率、术中情况、术后情况、并发症发生情况及5年生存率。结果与对照组相比,支架组造口率低(4.0%vs. 91.8%)、手术时间短(P<0.001)、切口小(P<0.001)、出血少(P<0.001)、淋巴结清扫数目多(P=0.020)、排气时间短(P=0.024)、进食流质时间早(P=0.009)、止痛药使用时间短(P<0.001)、术后住院时间短(P<0.001)、造口并发症(P=0.027)及切口感染并发症少(P=0.031),差异均有统计学意义(均P<0.05)。与对照组相比,支架组术中肿瘤大小(P=0.398)、住院费用(P=0.498)、术后出血(P=0.495)、吻合口瘘(P=0.320)、肠梗阻(P=0.204)及5年生存率(P=0.527)相似,差异均无统计学意义(均P>0.05)。结论支架联合腹腔镜治疗结直肠癌伴梗阻患者近期疗效优势明显,远期疗效相当,并不增加肿瘤扩散转移风险,推荐用于梗阻性结直肠癌的治疗。

Objective To investigate the effect of stent combined with laparoscopic surgery on the prognosis of colorectal cancer patients with obstruction. Methods According to the different operation methods, 98 colorectal cancer patients with obstruction admitted in our hospital from January 2009 to January 2013 were divided into the stent group(stent placement first, followed by laparoscopic one-stage anastomosis) and the control group(conventional emergency laparotomy), 49 cases each group. The stoma rate, intraoperative condition, postoperative condition, complications and 5-year survival rate were compared between the two groups. Results Compared with the control group, the stent group had lower stoma rate(4.0% vs. 91.8%), shorter operation time(P<0.001), smaller incision(P<0.001), less bleeding(P<0.001), more lymph node dissection(P=0.020), shorter postoperative exhaust time(P=0.024), earlier fluid intake time(P=0.009), shorter painkiller use time(P<0.001), shorter postoperative hospital stay(P<0.001), fewer complications of stoma(P=0.027) and fewer complications of wound infection(P=0.031). The tumor size(P=0.398), hospitalization cost(P=0.498), postoperative bleeding(P=0.495), anastomotic leakage(P=0.320), intestinal obstruction(P=0.204) and 5-year survival rate(P=0.527) were similar in the two groups. Conclusion Stent combined with laparoscopic treatment of colorectal cancer patients with obstruction has obvious short-term efficacy, similar long-term efficacy, and does not increase the risk of tumor spread and metastasis. It is recommended for the treatment of obstructive colorectal cancer.