肠造口术与肠道支架置入术后择期手术治疗梗阻性左半结肠癌的效果

Effect of Elective Surgery after Enterostomy or Intestinal Stent Implantation in the Treatment of Obstructive Left Colon Cancer

目的:比较肠造口术与肠道支架置入术后择期手术治疗梗阻性左半结肠癌的效果。方法:回顾性分析2017年1月—2021年12月莆田市第一医院收治的90例梗阻性左半结肠癌患者的临床资料。根据解除结肠梗阻方式的不同将其分为造口组(n=42)和支架组(n=48)。造口组给予肠造口术,支架组给予肠道支架置入术。比较两组根治性手术情况、并发症、预后情况。结果:造口组术前等待时间、手术时间长于支架组,术后肠造口占比高于支架组,差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。90例患者术后随访时间13~72个月,中位随访时间39.6个月;支架组术后随访期内支架组局部复发与远处转移率显著高于造口组,差异有统计学意义(P<0.05)。随访期内造口组与支架组分别有9例和18例患者死亡,两组生存率(78.57%vs 62.50%)比较,差异无统计学意义(χ^(2)=2.774,P>0.05)。结论:梗阻性左半结肠癌的治疗中,肠道支架置入术后择期手术的短期效果优于肠造口术,但其可能增加术后肿瘤复发、转移发生率,影响远期治疗效果。

Objective:To compare the effect of elective surgery after enterostomy or intestinal stent implantation in the treatment of obstructive left colon cancer.Method:The clinical data of 90 patients with obstructive left colon cancer admitted to Putian First Hospital from January 2017 to December 2021 were retrospectively analyzed.The patients were divided into stoma group(n=42)and stent group(n=48)according to different ways of removing colonic obstruction.The stoma group was given the enterostomy,and the stent group was given intestinal stent implantation.The radical surgery situation,complications and prognosis situation were compared between the two groups.Result:The preoperative waiting time and operation time in the stoma group were longer than those in the stent group,and the proportion of postoperative enterostomy was higher than that in the stent group,the difference was statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).The postoperative follow-up time of 90 patients was 13 to 72 months,with a median follow-up time of 39.6 months;during the postoperative follow-up period,the local recurrence and distant metastasis rate in the stent group was significantly higher than that in the stoma group,the difference was statistically significant(P<0.05).During the follow-up period,9 patients in the stoma group and 18 patients in the stent group died respectively.The survival rates of the two groups(78.57%vs 62.50%)were compared,and there was no statistically significant difference(χ^(2)=2.774,P>0.05).Conclusion:In the treatment of obstructive left colon cancer,the short-term effect of selective surgery after intestinal stent implantation is better than that of enterostomy,but it may increase the incidence of postoperative tumor recurrence and metastasis,affecting the long-term treatment effect.