术前经肛门肠梗阻导管减压后的Ⅰ期根治性切除吻合术对左半结肠癌急性肠梗阻患者的临床疗效

Clinical effect of primary radical resection and anastomosis after preoperative transanal intestinal obstruction catheter decompression on patients with acute intestinal obstruction of left colon cancer

目的对比Ⅰ期根治性切除吻合术联合近端结肠灌洗和先放置结肠减压管后择期行Ⅰ期切除吻合术治疗左半结肠癌急性肠梗阻的疗效、并发症及对预后的影响。方法回顾性分析2012年3月至2018年2月于我院行Ⅰ期根治性切除吻合术治疗的113例左半结肠癌急性肠梗阻患者的病例资料,其中40例联合近端结肠灌洗(灌洗组),73例先放置结肠减压管后择期行Ⅰ期切除吻合术(结肠减压管组)。比较两组患者疗效(手术时间、术中出血量、排气时间、术后引流管留置时间、住院时间)、术后并发症(呕吐、吻合口瘘、切口感染、腹腔感染发生率)和总生存率(OS)。COX比例风险回归模型筛选影响患者OS的独立预后因素。结果结肠减压管组的手术时间、术中出血量、排气时间、术后引流管留置时间和住院时间均较灌洗组短,差异具有统计学意义(P均<0.05)。结肠减压管组总并发症发生率为1.4%,灌洗组为30.0%,差异具有统计学意义(P<0.001)。结肠减压管组的中位OS为30个月,低于灌洗组(中位OS为60个月),差异具有统计学意义(P<0.001)。Cox多因素分析结果显示,肿瘤TNM分期、肿瘤分化程度、手术方式是影响患者OS的独立预后因子(HR=1.34、1.79、1.92;P<0.05)。结论与Ⅰ期根治性切除吻合联合近端结肠灌洗术比较,术前经肛门肠梗阻导管减压后的Ⅰ期根治性切除吻合治疗左半结肠癌急性肠梗阻的并发症更少,但是不利于改善患者远期预后。

Objective To compare the efficacy,complications and prognosis of primary radical resection and anastomosis combined with proximal colonic lavage and selective primary resection and anastomosis after placement of colonic decompression tube in the treatment of acute intestinal obstruction of left colon cancer.Methods The case data of 113 patients with acute intestinal obstruction of left colon cancer treated by primary radical resection and anastomosis in our hospital from March 2012 to February 2018 were analyzed retrospectively,including 40 cases combined with proximal colonic lavage(lavage group),and 73 cases underwent primary resection and anastomosis after placement of colonic decompression tube(colonic decompression tube group).The curative effects(operation time,intraoperative bleeding,exhaust time,postoperative drainage tube retention time,hospital stay),postoperative complications(vomiting,anastomotic fistula,incision infection,abdominal infection),and overall survival rate(OS)were compared between the two groups.Cox regression model was used to screen independent prognostic factors affecting OS.Results There were significant differences in the amount of bleeding in the operation group and the length of stay in the drainage group(P<0.05).The total complication rate was 1.4%in colon decompression tube group and 30.0%in lavage group(P<0.001).The median OS of colon decompression tube group was 30 months,which was lower than that of lavage group(median OS was 60 months),and the difference was statistically significant(P<0.001).Cox multivariate analysis showed that TNM stage,tumor differentiation and operation mode were independent prognostic factors affecting OS(HR=1.34,1.79 and 1.92;P<0.05).Conclusion Compared with primary radical resection and anastomosis combined with proximal colonic lavage,primary radical resection and anastomosis after preoperative transanal intestinal obstruction catheter decompression has fewer complications in the treatment of acute intestinal obstruction of left colon cancer,but it is not conducive to improving the long-term prognosis of patients.