结肠支架联合腹腔镜手术治疗梗阻性左半结肠癌手术效果及中长期预后的观察评价

Evaluation of surgical results and medium and long term prognosis of colon stenting combined with laparoscopic surgery for obstructive left hemi-colon cancer

目的探讨结肠支架联合腹腔镜手术对梗阻性左半结肠癌患者短期手术效果和中长期预后的影响。方法选取临沂市人民医院2016年1月至2019年6月收治的67例梗阻性左半结肠癌患者,并按照不同治疗方式将患者分为支架组30例,急症组37例,另随机选取30例未梗阻的左半结直肠癌患者作为对照组,比较三组患者的短期疗效和中长期预后。结果三组患者的性别、年龄、体质量指数(body mass index,BMI)、美国麻醉医师协会(American Society of Anesthesiologists,ASA)评分、TNM分期、肿瘤部位、合并症等临床资料差异均无统计学意义(P>0.05)。支架组及对照组患者的术中出血量、肠造口率、预防性小肠造口率、结肠造口率低于急症组,差异均有统计学意义(P<0.05)。支架组及对照组患者的一期吻合率高于急症组,差异有统计学意义(χ^(2)=14.80,P<0.05)。支架组及对照组患者术后住院时间明显短于急症组,差异有统计学意义(F=5.448,P<0.05)。三组患者的手术时间、淋巴结清扫数目、术后电解质紊乱、术后白细胞水平、术后排气时间、术后进食时间、围手术期死亡、术后化疗等指标差异均无统计学意义(P>0.05)。急症组的并发症发生率与切口感染率高于支架组和对照组,差异有统计学意义(P<0.05)。三组患者的吻合口瘘、切口出血、肺栓塞、肺部感染、下肢静脉血栓等指标差异均无统计学意义(P>0.05)。三组患者的3年无病生存率和总生存率差异无统计学意义(P>0.05)。结论对于梗阻性左半结肠癌患者,支架联合腹腔镜手术的治疗方式能减少造口,提高手术一期吻合率,减少并发症的发生,但对中远期生存没有明显影响。

Objective To investigate the effects of colonic stenting combined with laparoscopic surgery on short term surgical outcomes and medium and long term prognosis in patients with obstructive left hemi-colon cancer.Methods A total of 67 patients with obstructive left hemico-rectal cancer admitted to Linyi People’s Hospital from January 2016 to June 2019 were selected and divided into 30 cases in the stent group and 37 cases in the acute group according to different treatment modalities,and another 30 patients with unobstructed left hemico-rectal cancer were randomly selected as the control group to compare the short term efficacy and medium and long term prognosis of patients in the three groups.Results The differences in clinicopathological data such as gender,age,body mass index(BMI),American Society of Anesthesiologists(ASA)score,TNM stage,tumor site,and comorbidities among the three groups were not statistically significant(P>0.05).The bleeding volume,enterostomy rate,prophylactic small colostomy rate and colostomy rate in the stent group and control group were lower than those in the acute group,and the differences were statistically significant(P<0.05).The stent group and the control group had a higher rate of first-stage anastomosis than the acute group,and the difference was statistically significant(χ^(2)=14.80,P<0.05).The postoperative hospital stay was significantly shorter in the stent and control groups than in the acute group,and the difference was statistically significant(F=5.448,P<0.05).There were no statistically significant differences between the three groups in terms of operative time,number of lymph node dissection,postoperative electrolyte disorders,postoperative white blood cell levels,postoperative time of exhaustion,postoperative time of feeding,perioperative death,and postoperative chemotherapy(P>0.05).The incidence of complications and incisional infections in the acute group were statistically higher than those in the stent and control groups(P<0.05).The differences in anastomotic fistula,bleeding from the incision,pulmonary embolism,pulmonary infection,and lower extremity venous thrombosis were no statistically significant among the three groups(P>0.05).There was no statistically significant difference in the 3-year disease-free survival rate and overall survival rate among the three groups(P>0.05).Conclusion In patients with obstructive left hemicolonic cancer,stenting combined with laparoscopic surgery reduces stoma,improves the rate of one-stage surgical anastomosis,and reduces complications,but does not have a significant impact on mid-and long-term survival.