暂时性金属内支架和急诊手术治疗梗阻性结直肠癌的疗效比较

Temporary internal metal stent versus emergency surgery for colorectal cancer obstruction:comparison of efficacy

目的对比X线引导内镜下暂时性金属内支架和急诊手术治疗梗阻性结直肠癌的临床疗效。方法纳入上海市第六人民医院1998年6月至2021年6月收治的因梗阻性结直肠癌行金属内支架置入术的患者408例,另随机选取同期因结直肠癌梗阻行急诊手术的312例患者,比较两组患者的Ⅰ期吻合率、住院时间、住院费用、患者满意度、术后并发症发生率、术后2年内复发率、术后3年生存率。结果支架置入组中365例成功置入金属内支架,置入成功率89.46%,其中318例做了选择性Ⅰ期结肠癌切除及结肠吻合术,9例因支架术后感染行结肠造瘘术,另外38例患者支架永久置入作为一种姑息治疗。急诊手术组312例患者和支架置入组327例患者的住院时间分别为(22.3±3.5)d和(16.1±4.2)d,住院费用分别为(61762.46±8932.76)元和(45592.35±11231.45)元,Ⅰ期吻合率分别为67.63%和97.25%,患者满意度分别为3.34±0.65和3.52±0.84,差异均有统计学意义(均P<0.05);两组术后并发症发生率分别为10.5%(33/312)和7.03%(23/327),术后2年内复发率分别为25.96%(81/312)和23.24%(76/327),术后3年生存率分别为89.10%(278/312)和87.77%(287/327),差异均无统计学意义(P=0.113、0.425、0.598)。结论暂时性金属内支架置入可以有效地解除结直肠癌急性梗阻症状,支架置入成功率较高、并发症发生率较低,Ⅰ期手术吻合率高,缩短了住院时间,节约了医疗成本,患者满意度明显提高。

Objective To compare the clinical efficacy of X-ray-guided endoscopic temporary internal metal stent implantation and emergency surgery for malignant colorectal obstruction.Methods A total of 408 patients with malignant colorectal obstruction,who were admitted to the Shanghai Municipal Sixth People’s Hospital of China to receive temporary internal metal stent implantation between June 1998 and June 2021,were enrolled in this study(stent group).In addition,312 patients who underwent emergency surgery for colorectal cancer obstruction in the same period were randomly selected(surgery group).StageⅠanastomosis rate,length of hospitalization stay,hospitalization cost,patient satisfaction,incidence of postoperative complications,recurrence rate within 2 years,and postoperative 3-year survival rate were compared between the two groups.Results Successful stent implantation was accomplished in 365 patients of the stent group with a success rate of stent implantation of 89.46%.Of the 365 patients,selective stageⅠcolon cancer resection together with colocolic anastomosis was carried out in 318,colostomy was adopted in 9 due to post-stenting infection,and the stent was permanently placed as a palliative treatment in 38.In the 312 patients of surgery group and the 327 patients of stent group,the length of hospitalization stay was(22.3±3.5)days and(16.1±4.2)days respectively,the hospitalization cost was(61762.46±8932.76)Chinese yuan and(45592.35±11231.45)Chinese yuan respectively,the stageⅠanastomosis rate was 67.63%and 97.25%respectively,and the patient satisfaction was(3.34±0.65)and(3.52±0.84)respectively,the differences in all the above indexes were statistically significant(all P<0.05).In the 312 patients of surgery group and the 327 patients of stent group,the incidence of postoperative complications was 10.5%(33/312)and 7.03%(23/327)respectively,the recurrence rate within 2 years was 25.96%(81/312)and 23.24%(76/327)respectively,and the postoperative 3-year survival rate was 89.10%(278/312)and 87.77%(287/327)respectively,the differences in all the above indexes were not statistically significant(P=0.113,P=0.425 and P=0.598 respectively).Conclusion The temporary internal metal stent implantation can effectively relieve the acute obstructive symptoms caused by colorectal cancer.This technique has several advantages such as higher success rate of stent implantation,lower incidence of stentrelated complications,and higher stageⅠsurgical anastomosis rate,which can shorten the length of hospitalization stay,save the medical costs,and significantly improve the patient satisfaction.