支架置入术后取不同时间间隔行限期手术治疗梗阻性左半结肠癌的临床资料分析

Clinical observation of different time intervals between stenting and confine operation in patients with left-sided obstructive colon cancer

目的分析支架置入术后取不同时间间隔行限期手术治疗梗阻性左半结肠癌的临床效果。方法回顾性分析2016年1月至2017年6月于苏州高新区人民医院收治的因梗阻性左半结肠癌行内镜下结肠支架置入术后行限期手术的129例患者的临床资料。根据内镜下结肠支架置入术与限期手术时间间隔的不同将患者分为A组(>8 d,75例)和B组(≤8 d,54例)。记录限期手术相关情况、造口率、两次手术总住院时间,以及术后生存与复发情况。结果A组限期手术的手术时间为(154.5±60.7)min,术中出血量为(122.0±50.0)mL,淋巴结清扫数目为(16.3±4.0)枚,肠功能恢复时间为(3.6±0.5)d,术后住院时间为(14.1±6.0)d。B组相应分别为(211.0±102.1)min、(200.5±70.2)mL、(17.6±4.1)枚、(2.4±0.4)d、(12.3±4.1)d。A组术后发生吻合口漏1例,肺部感染3例,切口感染1例,腹泻2例,无吻合口出血、肠梗阻病例;B组吻合口出血1例,肺部感染2例,切口感染1例,腹泻1例,肠梗阻1例,无吻合口漏病例。A组造口率为10.7%(8/75),B组为20.4%(11/54)。A组总住院时间为(26.8±10.0)d,B组为(23.9±6.7)d。中位随访时间16个月,A组复发率为25%(10/40),B组为27.6%(8/29);A组死亡35例,B组死亡25例。结论对于梗阻性左半结肠癌而言,内镜下结肠支架置入术与限期手术的时间间隔超过8 d时,与8 d及以下相比临床效果基本相当,但延长间隔时间应一定程度上有助于限期手术术后恢复。

Objectives To investigate the effect of different time intervals between stenting and confine operation on clinical outcomes in patients with left-sided obstructive colon cancer.Methods This was a retrospective analysis of 129 patients with leftsided obstructive colon cancer who received endoscopic stenting followed by confine operation at the People’s Hospital of NED between January 2016 and June 2017.Patients were divided into Group A and Group B depending on the interval between stenting and confine operation.The time interval was>8 days in Group A(n=75)and≤8 days in Group B(n=54).The following were compared between the two groups:surgical parameters of confine operation,proportion of patients receiving stoma,total length of hospital stay for both stenting and confine operation,postoperative survival,and recurrence.Results For confine operation in group A,the mean(SD)operation time was 154.5(60.7)min,the mean(SD)intraoperative blood loss was 122.0(50.0)mL,the lymph node yield was 16.3(4.0),the mean(SD)time to intestinal function recovery was 3.6(0.5)days,and the mean(SD)postoperative hospitalization was 14.1(6.0)days.The corresponding figures in Group B was 211.0(102.1)min,200.5(70.2)mL,17.6(4.1),2.4(0.4)days,and 12.3(4.1)days.In Group A,one patient experienced anastomotic leakage,three experienced lung infection,one experienced incision infection,two experienced diarrhea,and none had anastomotic bleeding or intestinal obstruction.In Group B,one patient experienced anastomotic bleeding,two lung experienced infection,one experienced incision infection,one experienced diarrhea,one experienced intestinal obstruction,and none experienced anastomotic leakage.Eight out of 75(10.7%)patients in Group A and 11 out of 54(20.4%)in Group B received stoma.The mean(SD)total length of hospital stay was 26.8(10.0)days in Group A and 23.9(6.7)days in Group B.The median follow-up was 16 months.Ten out of 40(25%)patients in Group A and eight out of 29(27.6%)in Group B had recurrence.Thirty-five patients in Group A and twenty-five patients in Group B died.Conclusion The efficacy was comparable between patients with left-sided obstructive colon cancer who received confine operation after stenting with an interval of>8 days and≤8 days.However,a longer interval may promote the postoperative recovery of confine operation.