自膨式金属支架置入后择期手术与急诊手术治疗左半结肠癌伴急性肠梗阻患者的疗效比较

Short-term results from colonic stenting as a bridge to selective surgery versus emergency surgery for obstructing left-sided colon cancer:a randomized controlled trial

目的 比较自膨式金属支架(self-expanding metal stent,SEMS)置入与急诊手术(emergency surgery,ES)治疗左半结肠癌伴急性肠梗阻的临床疗效。方法 前瞻性收集2020年12月至2022年10月期间在南京医科大学附属苏州医院就诊的左半结肠癌伴急性肠梗阻患者的临床资料。使用随机数表法1∶1分配至SEMS组和ES组,主要结局指标为造口率和腹腔镜手术率。结果 最终纳入分析的SEMS组18例,ES组20例。SEMS组有更低的造口率(16.7%vs.65.0%,P=0.004),更多的淋巴结清扫数(18.28 vs.13.25,P=0.01)。SEMS组接受腹腔镜手术的患者比例显着高于ES组(66.7%vs.10.0%,P=0.001)。SEMS组的术后并发症发生率低于ES组(22.2%vs.40.0%,P=0.025)。结论 与ES相比,SEMS置入在治疗左半结肠癌伴急性肠梗阻的手术短期结果方面具有明显优势:更低的造口率,更少的术后并发症,更高的微创手术率,更符合现代微创外科及加速康复理念。

Objective To compare self-expanding metal stent with emergency surgery in the treatment of obstructing left-sided colon cancer.Methods Subjects adult patients with an obstructing left-sided colon cancer between the splenic flexure and rectosigmoid junction were studied and assigned(1:1 ratio) to the SEMS group and the ES group using the Random Number Table.Main outcome:stoma rate and endolaparoscopic approach.Results The stoma rate was 16.7% in the SEMS group versus 65.0 % in the ES group(P=0.004).There was a significantly better lymph node harvest in the SEMS group and the postoperative complication rate was 22.2%in the SEMS group versus 40% in the ES group(P = 0.025).Significantly more patients in the SEMS group had a endolaparoscopic approach performed than that in ES group(66.7% vs.10.0%;P = 0.001).Conclusion There was a significantly less stoma rate,postoperative complications and more endolaparoscopic approach compared with ES in the treatment of obstructing left-sided colon cancer.