肠道支架置入联合择期手术与急诊手术在梗阻性结直肠癌治疗中的对比分析

Comparative analysis of colon stent combined with elective surgery and emergency surgery in the treatment of obstructive colorectal carcinoma

目的:对比肠道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安全性、可行性及近期疗效。方法:回顾分析2013年1月至2019年6月收治的148例梗阻性结直肠癌患者的临床资料,其中42例行肠道支架置入联合择期手术(CSCES),106例行急诊手术(ES)。对比两组患者基本信息、病理资料、术中情况、术后恢复情况及并发症情况。结果:CSCES组中肠道支架置入与手术的间隔时间为(8.3±2.0)d。与ES组相比,CSCES组术中出血量[(88.3±54.9)min vs.(108.7±53.2)min,P=0.041]更少,淋巴结清扫数量[(20.4±6.2)vs.(17.4±4.4),P=0.001]更多,Ⅰ期吻合率(83.3%vs.53.8%,P=0.001)、腔镜手术率(45.2%vs.5.7%,P=0.001)更高,造口率(23.8%vs.55.7%,P=0.001)、永久造口率(16.7%vs.48.1%,P=0.001)更低,术后住院时间[(10.79±5.05)d vs.(12.73±5.00)d,P=0.036]更短,术后通气[(2.12±0.73)d vs.(2.44±0.83)d,P=0.029]更早,差异有统计学意义。结论:肠道支架置入联合择期手术治疗梗阻性结直肠癌安全、可靠,并且在提高Ⅰ期吻合率、降低造口率、促进患者术后恢复方面具有显著优势。

Objective:To compare the safety,feasibility and short-term efficacy of colon stent implantation combined with elective surgery and emergency surgery in the treatment of obstructive colorectal cancer.Methods:The clinical data of 148 patients with obstructive colorectal cancer from Jan.2013 to Jun.2019 were retrospectively analyzed,including 42 cases of colon stent implantation combined with elective surgery(CSCES)and 106 cases of emergency surgery(ES).The basic information,pathological data,intraoperative conditions,postoperative recovery and complications of the two groups were compared.Results:The mean interval between stent placement and operation was(8.3±2.0)d in CSCES group.Compared with the ES group,the CSCES group had less hemorrhage during operation[(88.3±54.9)min vs.(108.7±53.2)min,P=0.041],more lymph node dissection[(20.4±6.2)vs.(17.4±4.4),P=0.001],higher Ⅰ-stage anastomosis rate(83.3%vs.53.8%,P=0.001)and endoscopic surgery rate(45.2%vs.5.7%,P=0.001),lower colostomy rate(23.8%vs.55.7%,P=0.001)and permanent colostomy rate(16.7%vs.48.1%,P=0.001),shorter postoperative hospital stay[(10.79±5.05)d vs.(12.73±5.0)d,P=0.036]and earlier postoperative ventilation time[(2.12±0.73)d vs.(2.44±0.83)d,P=0.029].Conclusions:Colon stent implantation combined with selective surgery is safe and reliable in the treatment of obstructive colorectal cancer,and it has significant advantages in improving the rate of stage Ⅰ anastomosis,reducing the rate of colostomy and accelerating postoperative recovery.