置入自膨式金属支架桥接手术治疗梗阻性结肠癌的效果及安全性

Efficacy and safety of placing self-expanding metallic stent bridging surgery for obstructive colon cancer

目的比较置入自膨式金属支架(SEMS)桥接手术与急诊手术治疗结肠癌梗阻患者的效果及安全性。方法回顾性队列研究。回顾性分析山西省肿瘤医院2017年1月至2020年4月收治的111例结肠癌伴梗阻患者的临床资料,按治疗策略不同分为急诊组(急诊行根治性手术,44例)和支架组(肠内置入SEMS后择期行根治性手术,67例)。比较两组一般资料、手术相关指标及术后复发转移情况等。采用Kaplan-Meier法进行生存分析;采用Cox比例风险模型分析预后影响因素。结果111例患者中,男性69例,女性42例,年龄(61±13)岁。急诊组与支架组一般资料比较,差异均无统计学意义(均P>0.05)。支架组腹腔镜手术患者占比高于急诊组[32.84%(22/67)比6.82%(3/44),P=0.001],淋巴结检出数≥12枚患者占比高于急诊组[94.03%(63/67)比79.55%(35/44),P=0.020];急诊组预防造口患者占比高于支架组[36.36%(16/44)比17.91%(12/67),χ^(2)=4.80,P=0.029],术后住院时间长于支架组[14 d(10 d,17 d)比11 d(10 d,14 d),Z=-2.00,P=0.045]。两组术后病理TNM分期、脉管浸润、神经侵犯、局部复发和远处转移等差异均无统计学意义(均P>0.05)。急诊组和支架组3年无病生存率差异无统计学意义(52.3%比64.2%,χ^(2)=2.22,P=0.142),3年总生存率差异无统计学意义(56.8%比73.1%,χ^(2)=3.02,P=0.087)。多因素Cox回归分析结果显示,肿瘤位置、TNM分期、脉管浸润是梗阻性结肠癌患者3年无病生存的独立影响因素(均P<0.05);年龄、肿瘤位置、TNM分期、脉管浸润是梗阻性结肠癌患者3年总生存的独立影响因素(均P<0.05)。结论与急诊手术相比,置入SEMS桥接手术治疗梗阻性结肠癌安全可靠,肿瘤位置、TNM分期、脉管浸润与预后密切相关。

Objective To compare the efficacy and safety of placing self-expanding metallic stent(SEMS)and emergency surgery in treatment of patients with obstructive colon cancer.Methods A retrospective cohort study was conducted.The clinical data of 111 colon cancer patients with obstruction admitted to Shanxi Province Cancer Hospital from January 2017 to April 2020 were retrospectively analyzed,and all patients were divided into the emergency group(44 cases receiving emergency radical surgery)and the stenting group(67 cases receiving elective radical surgery after intra-intestinally placing SEMS).General data,operation-related indexes and postoperative recurrence and metastasis of both groups were compared.The Kaplan-Meier method was used for survival analysis,and Cox proportional risk model was used to analyze the factors influencing the prognosis.Results Among 111 patients,69 cases were male and 42 cases were female;the age was(61±13)years.There were not statistically significant differences in the general data between the emergency group and the stenting group(all P>0.05).The proportion of patients receiving laparoscopic surgery in the stenting group was higher than that in the emergency group[32.84%(22/67)vs.6.82%(3/44),P=0.001];the proportion of patients with the detected number of lymph nodes≥12 in the stenting group was higher than that in the emergency group[94.03%(63/67)vs.79.55%(35/44),P=0.020];the proportion of patients with stoma prevention in the emergency group was higher than that in the stenting group[36.36%(16/44)vs.17.91%(12/67),χ^(2)=4.80,P=0.029],and the duration of postoperative hospitalization in the emergency group was longer than that in the stenting group[14.0(10 d,17 d)vs.11 d(10 d,14 d),Z=-2.004,P=0.045].There were no statistically significant differences in postoperative pathological TNM staging,vascular infiltration,nerve invasion,local recurrence and distant metastasis between the 2 groups(all P>0.05).The difference in 3-year disease-free survival rate was statistically significant between the emergency group and the stenting group(52.3%vs.64.2%,χ^(2)=2.2,P=0.142),and difference in 3-year overall survival rate was statistically significant between the emergency group and the stenting group(56.8%vs.73.1%,χ^(2)=3.02,P=0.087).The multivariate Cox regression analysis showed that tumor location,TNM staging,and vascular infiltration were independent influencing factors for 3-year disease-free survival of patients with obstructive colon cancer(all P<0.05);age,tumor location,TNM staging,and vascular infiltration were independent influencing factors for 3-year overall survival of patients with obstructive colon cancer(all P<0.05).Conclusions Compared with emergency surgery,placement of SEMS bridging surgery for obstructive colon cancer is safe and reliable,and tumor location,TNM staging,and vascular infiltration are closely related to prognosis.