经鼻(肛)型肠梗阻导管联合动脉灌注化疗治疗大肠癌腹膜转移合并恶性肠梗阻的临床疗效

Clinical Effect of Intestinal Obstruction Catheter Combined with Arterial Infusion Chemotherapy in the Treatment of Peritoneal Metastasis of Colorectal Cancer with Malignant Intestinal Obstruction

目的观察经鼻(肛)型肠梗阻导管联合动脉灌注化疗治疗大肠癌腹膜转移合并恶性肠梗阻患者的临床疗效,并进一步分析影响患者预后的因素,为临床综合治疗提供参考。方法回顾性分析2017年7月1日—2019年7月1日于我科就诊的符合纳入和排除标准的230例大肠癌腹膜转移合并肠梗阻患者,以采用肠梗阻减压管置入术治疗为基础,将所有患者分为两组,其中对照组110例患者采用基础治疗,观察组120例患者在此基础上待梗阻缓解后联合局部动脉灌注化疗。估算两组患者的中位再梗阻时间,采用Cox比例风险模型进行多因素分析。结果肠梗阻减压管置入术后3天,对照组、观察组梗阻缓解率分别为82.7%、85.0%(χ^2=0.084,P=0.773),再梗阻率分别为63.6%、35.8%(P<0.01),置管时间分别为(17.68±1.43)天、(17.34±1.33)天,再梗阻间隔时间分别为(7.7±0.79)天、(25.4±1.7)天。对照组术前及术后3个月CEA水平分别为(534.51±41.39)μg·L^-1、(922.82±42.16)μg·L^-1,观察组术前及联合灌注化疗后3个月CEA水平分别为(610.99±42.18)μg·L^-1、(295.34±27.91)μg·L^-1,组内及组间比较,差异均有统计学意义(P<0.01)。结论肠梗阻导管治疗大肠癌腹膜转移合并肠梗阻可明显改善患者的临床症状,血清CEA水平>500μg·L^-1的患者更容易复发肠梗阻,局部灌注化疗可减少恶性肠梗阻的复发。

Objective To observe the clinical effect of transnasal(anal)intestinal obstruction catheter combined with arterial infusion chemotherapy in the treatment of colorectal cancer patients with peritoneal metastasis combined with malignant intestinal obstruction,and further analyze the factors affecting the prognosis of patients,so as to provide clinical reference for comprehensive treatment.Methods A retrospective analysis was made of 230 patients with peritoneal metastasis of colorectal cancer and intestinal obstruction who met the acceptance criteria in our department between July 1,2017 and July 1,2019.Based on the treatment of intestinal obstruction decompression tube insertion,all patients were divided into two groups.110 patients in the control group were treated with basic treatment,and the other 120 patients in the observation group were treated with local arterial infusion chemotherapy after the obstruction was relieved.The mean time of reobstruction was estimated.The Cox proportional hazard model was used to make multiple factors analysis.Results At three days after the decompression tube insertion,the remission rate of obstruction in the control group and observation group was 82.7%and 85.0%,respectively(χ^2=0.084,P=0.773),and the reobstruction rate was 63.6%and 35.8%,respectively(P<0.01).The time of intubation was respectively(17.68±1.43)days and(17.34±1.33)days,and the interval of reobstruction was(7.7±0.79)days and(25.4±1.7)days,respectively.The CEA values of the control group were(534.51±41.39)μg·L^-1 and(922.82±42.16)μg·L^-1 before operation and 3 months after operation,respectively.The CEA values of the observation group were(610.99±42.18)μg·L^-1 and(295.34±27.91)μg·L^-1 before operation and 3 months after combined infusion chemotherapy,respectively.The differences were statistically significant within or between groups(P<0.01).Conclusion Intestinal obstruction catheter could significantly improve the clinical symptoms of patients with peritoneal metastasis of colorectal cancer combined with intestinal obstruction.Patients with tumor index CEA level higher than 500μg·L^-1 were more likely to have intestinal obstruction relapse.Local infusion chemotherapy could reduce the recurrence of malignant intestinal obstruction.