肠道支架在结直肠癌伴梗阻治疗中的应用效果

Application Effect of Intestinal Stents in the Treatment of Colorectal Cancer with Obstruction

目的 总结在结直肠癌伴梗阻患者治疗过程中肠道支架应用的经验。方法 回顾性分析2018年10月至2021年9月北京怀柔医院收治的54例结直肠癌伴梗阻患者的病历资料,按是否应用肠道支架治疗分为支架组(21例)和未行支架组(33例),对两组患者的后续治疗效果及转归进行分析及经验总结。结果 支架组21例患者中,有19例成功完成梗阻病变段的肠道支架置入术,随后有17例患者限期行腹腔镜下结直肠癌根治性切除术;未行支架组患者均接受手术治疗,15例完成腹腔镜下结直肠癌根治性切除术,支架组患者腹腔镜手术完成率高于未行支架组,加做预防性造口术率及吻合口瘘发生率低于未行支架组,两组数据差异有统计学意义(P <0.05)。结论 结直肠癌伴梗阻的临床治疗要根据患者基础条件及病情情况,个体化的选择治疗方案,方能使得患者获得最大收益。如条件允许,先行肠道支架置入术以快速缓解病变段梗阻,改善患者基础条件,亦能增加患者一期手术吻合的成功率,降低患者术后相关并发症发生率。

Objective To summarize the experience of application of intestinal stents in the treatment of colorectal cancer with obstruction.Methods A total of 54 colorectal cancer patients with obstruction admitted to Beijing Huairou Hospital from October 2018 to September 2021 were retrospectively analyzed.They were divided into stent group(21 cases)and non-stent group(33 cases)according to whether intestinal stenting was used.The follow-up treatment effect and outcome of the two groups were analyzed and the experience was summarized.Results Among the 21 patients in the stenting group,19 patients successfully underwent intestinal stenting in the obstructive lesion segment,and 17 patients subsequently underwent laparoscopic radical resection of colorectal cancer in a limited period.Fifteen patients completed laparoscopic radical resection of colorectal cancer.The completion rate of laparoscopic surgery in the stenting group was higher than that in the non-stenting group,and the rate of additional prophylactic stoma and the incidence of anastomotic leakage were lower than those in the non-stenting group.There was a difference between the two groups(P<0.05).Conclusion The treatment choose of colorectal cancer with obstruction should be based on the basic condition of the patients,the individual selection of the treatment can help the patients to receive the maximum benefit.If the condition of the patients is permits,early placement of intestinal stent can relieve the obstruction rapidly and improve the patient's basic conditions,as well as increase the success rate of one-stage anastomosis in surgery and reduce the incidence of postoperative complications.