注水辅助肠镜下金属支架置入在治疗急性结直肠癌性梗阻中的应用研究

Application research of metal stent implantation via colonoscopy assisted by water injection for acute colorectal cancer obstruction

目的探讨注水辅助肠镜下放置肠道金属支架在治疗急性结直肠癌性梗阻中的临床应用价值。方法回顾性研究163例结直肠癌并发急性癌性肠梗阻患者的临床资料,其中85例行注水辅助肠镜下放置肠道金属支架的患者纳入研究组,78例行急诊手术的患者纳入对照组。评估研究组患者注水辅助肠镜下肠道金属支架放置成功率、治疗有效率、穿孔发生率、择期手术率、择期腹腔镜手术成功率,对比两组患者手术相关指标、永久性造口发生率以及远期疗效。结果研究组患者经注水辅助肠镜放置金属支架的成功率为82.4%,治疗梗阻的有效率为75.3%,穿孔发生率为4.7%,择期手术率为75.3%,择期腹腔镜手术成功率为41.2%。研究组支架置入后永久性造口发生率低于对照组(8.2%vs.19.2%,P<0.05);研究组住院天数较对照组显著缩短[(15.0±3.2)d vs.(28.0±4.3)d,P<0.05)];研究组化疗开始时间较对照组提前[(31.0±4.5)d vs.(55.0±6.1)d,P<0.05]。两组生存时间、无进展生存时间差异无统计学意义(均P>0.05)。结论注水辅助肠镜下放置肠道金属支架治疗急性结直肠癌性梗阻,操作相对快速、简便,安全有效、并发症少,值得在临床进一步推广。

Objective To explore the clinical application value of intestinal metal stent implantation via colonoscopy assisted by water injection for acute colorectal cancer obstruction.Methods Clinical data of 163 patients with colorectal cancer complicated with acute malignant intestinal obstruction were retrospectively analyzed,among which 85 patients were enrolled to the research group,who underwent intestinal metal stent implantation via colonoscopy assisted by water injection,whereas 78 patients underwent emergency operation were enrolled to the control group.Those rates of success of intestinal metal stent implantation via colonoscopy assisted by water injection,therapeutic effect,perforation occurrence,elective operation,and success of elective laparoscopic operation in the research group were evaluated.The related operative indicators,incidence of permanent stoma and long-term efficacy were compared between the two groups.Results The rates of success of intestinal metal stent implantation via colonoscopy assisted by water injection,therapeutic effect of obstruction,perforation occurrence,elective operation,and success of elective laparoscopic operation were 82.4%,75.3%,4.7%,75.3%,and 41.2%in the research group.Compare to the control group,the research group yielded lower incidence of permanent stoma after stent implantation(8.2%vs.19.2%,P<0.05),shorter hospital stays[(15.0±3.2)d vs.(28.0±4.3)d,P<0.05],and earlier start time of chemotherapy[(31.0±4.5)d vs.(55.0±6.1)d,P<0.05].There were no statistically significant differences in survival time and progression-free survival time between the two groups(all P>0.05).Conclusion Intestinal metal stent implantation via colonoscopy assisted by water injection for treating acute colorectal cancer obstruction has celerity and convenience of operation,and it is safe,effective,with less complication.Thus it is worthy of further promotion in clinic.