Additive manufacturing technologies of porous metal implants

Biomedical metal materials with good corrosion resistance and mechanical properties are widely used in orthopedic surgery and dental implant materials,but they can easily cause stress shielding due to the significant difference in elastic modulus between the implant and human bones.The elastic modulus of porous metals is lower than that of dense metals.Therefore,it is possible to adjust the pore parameters to make the elastic modulus of porous metals match or be comparable with that of the bone tissue.At the same time,the open porous metals with pores connected to each other could provide the structural condition for bone ingrowth,which is helpful in strengthening the biological combination of bone tissue with the implants.Therefore,the preparation technologies of porous metal implants and related research have been drawing more and more attention due to the excellent features of porous metals.Selective laser melting(SLM)and electron beam melting technology(EBM)are important research fields of additive manufacturing.They have the advantages of directly forming arbitrarily complex shaped metal parts which are suitable for the preparation of porous metal implants with complex shape and fine structure.As new manufacturing technologies,the applications of SLM and EBM for porous metal implants have just begun.This paper aims to understand the technology status of SLM and EBM,the research progress of porous metal implants preparation by using SLM and EBM,and the biological compatibility of the materials,individual design and manufacturing requirements.The existing problems and future research directions for porous metal implants prepared by SLM and EBM methods are discussed in the last paragraph.

The Tissue Reactions and Changes of a Surface of Various Metal Implants after Their Introduction in a Bone Tissue in Experiment

Screw metal implants (3S, Israel) with rough or smooth polished surface were introduced in a tibial proximal condyle of not purebred rabbits. The condition of surrounding tissues in 2 and 6 months after implantation was compared by light microscopy and X-ray methods. Within 6 months after operation the considerable distinctions of radiological and morphological data were revealed not. 2 months later after introduction of implants with a rough surface the effort enclosed for its twisting is, much more, than for removal of the polished product. However, stability of fixing of implants was practically made even at 6 months. On remote rough implants there is a set of tissue scraps whereas on products with a smooth surface the tissue remains were much less. Surrounding tissues strongly join a rough surface, grow into cavities, and during removal of such products there is a considerable trauma of tissues round an implantation place. Smooth implants have the smaller area of contact with organism tissues, they are fixed due to bicortical implantation, during removal easily get out and don’t break off surrounding tissues. The signs of inflammation and formation of merged multinuclear macrophages were not found at all cases, which give evidence to the inertness of material of the mentioned articles for living organism. In some observations however and by implantation of the rough article and by introduction of polished implants, metal particles were found, but after use of the foreign body with grit-blasted treatment of surface metal was found more frequently, and its fragments had larger volume.

Analysis of Accumulating Ability of Heavy Metals in Lotus (Nelumbo nucifera) Improved by Ion Implantation

Heavy metals have seriously contaminated soil and water, and done harm to public health. Academician WANG Naiyan proposed that ion-implantation technique should be exploited for environmental bioremediation by mutating and breeding plants or microbes. By implanting N^＋ into Taikonglian No.l, we have selected and bred two lotus cultivars, Jingguang No.1 and Jingguang No.2. The present study aims at analyzing the feasibility that irradiation can be used for remediation of soil and water from heavy metals. Compared with parent Taikonglian No.l, the uptaking and accumulating ability of heavy metals in two mutated cultivars was obviously improved. So ion implantation technique can indeed be used in bioremediation of heavy metals in soil and water, but it is hard to select and breed a cultivar which can remedy the soil and water from all the heavy metals.

Porcelain fracture of metal-ceramic tooth-supported and implant-supported restorations: A review

Metal-ceramic restorations are widely used in dentistry with a high degree of general success. However, fracture of these restorations does occur and usually frustrates both the dentist and the patient. Objective: This literature review discusses the factors that may lead to the fracture of these restorations whether they are tooth-supported or implant-supported with the aim of making dentists and technicians aware of these factors to avoid them. Factors reviewed include: technical factors, dentist-related factors, inherent material properties, direction, magnitude and frequency of applied loads, environmental factors, screw-retained implant-supported restorations, and posterior cantilevered prostheses. Material and Methods: A netbased search in “Pubmed” was performed and combined with a manual search. The search was limited to articles written in English. Conclusions: the published literature revealed that the factors predisposing to fracture of metal-ceramic restorations may be related to the technician, dentist, patient, environment, design of the restoration, or to inherent structure of ceramics and others. However, if the dentist and technician understand these factors and respect the physical characteristics of the materials, most of those are avoidable.

Investigation on the Tribology of Co Implanted Stainless Steel Using Metal Vapor Vacuum Arc Ion Source

AISI 304 stainless steel was ion implanted with Co, and the tribological property on the surface of the stainless steelwas investigated. The Co ion implantation was carried out using a metal vapor vacuum arc (Mevva) broad-beam ionsource with an extraction voltage of 40 kV, implantation doses of 3×10^(17)/cm^2 and 5×10^(17)/cm^2, and ion currentdensities of 13, 22 and 32μA/cm^2. The results showed that the near-surface hardness of Co-implanted stainless steelsample was increased by 50% or more, and it increased with increasing ion current density at first and then declined.The friction coefficient decreased from 0.74 to 0.20 after Co implantation. The wear rate after Co implantationreduced by 25% or more as compared to the unimplanted sample. The wear rate initially decreased with increasingion current density and then an increase was observed. Within the range of experimental parameters, there existsa critical ion current density for the Co-implanted stainless steel, at which the wear rate decreased with increasingretained dose, going through a minimum and then increased. The critical ion current density in this paper is about22μA/cm^2.

Inhibitory effect of ferroptosis inhibitor toxicity induced by cobalt nanoparticles through reactive oxygen species

BACKGROUND:Soft tissue damage induced by cobalt nanoparticles is currently the most noticeable complication in patients with artificial joint prostheses.Therefore,an effective therapeutic strategy is needed to limit the toxicity of cobalt nanoparticles.OBJECTIVE:To investigate the protective effect of a ferroptosis inhibitor on cobalt nanoparticles-induced cytotoxicity.METHODS:To evaluate the detoxification effect of ferroptosis inhibitor on mouse fibroblasts(Balb/3T3),Balb/3T3 cells were treated with cobalt nanoparticles and ferroptosis inhibitor for 24 hours.The cell viabilities were measured by cell viability assay.Based on the results of the cell viability assay,the concentrations of cobalt nanoparticles and deferiprone were determined.The experiment was divided into four groups:the cobalt nanoparticles group(400μmol/L cobalt nanoparticles),the cobalt nanoparticles+deferiprone group(400μmol/L cobalt nanoparticles and 25μmol/L deferiprone),the deferiprone group(25μmol/L deferiprone),and the control group.The expressions of glutathione peroxidase 4 and solute carrier family 7 member 11 protein were examined by western blot assay.RESULTS AND CONCLUSION:(1)The cell viability assay results showed that as the exposure time or the drug concentration increased,cell viability decreased further,indicating that the cytotoxic effect of cobalt nanoparticles was time-and dose-dependent.Additionally,after 24 hours of exposure,cobalt nanoparticles significantly reduced cell viability and glutathione levels compared with the control group(P<0.05).At the same time,compared with the control group,there was an increase in reactive oxygen species production,intracellular iron levels,and the expression of inflammatory cytokines such as tumor necrosis factorα,interleukin-1β,and interleukin-6.After the addition of deferiprone,compared with the cobalt nanoparticles group,cell viability significantly improved,and reactive oxygen species production,intracellular iron levels,and the expression of inflammatory cytokines(tumor necrosis factorα,interleukin-1β,and interleukin-6)significantly decreased(P<0.05).This demonstrated that deferiprone had a protective effect on cells exposed to cobalt nanoparticles.(2)Western blot assay results showed that cobalt nanoparticles reduced the expression of glutathione peroxidase 4 and solute carrier family 7 member 11 protein(P<0.05),while deferiprone inhibited this effect(P<0.05).(3)The above findings verify that cobalt nanoparticles are highly cytotoxic and ferroptosis inhibitor deferiprone has a detoxification effect on cytotoxicity induced by cobalt nanoparticles.Ferroptosis plays an important role in the process by which cobalt nanoparticles induce cytotoxicity.The inhibitory effect of ferroptosis inhibitors on the toxicity of cobalt nanoparticles may provide valuable insights for further research into the mechanisms of cobalt nanoparticle toxicity and potential detoxification strategies.

水泥基电池电解质性能及电池制备方法研究

电化学储能是目前建筑储能中实施性最大的方式之一,水泥基电池为结构与储能的融合发展提供了创新途径。从电解质性能和制备方法两个方面,研究影响水泥基电池电化学性能的关键因素。以电阻率衡量水泥基材料的导电性能,对比研究了导电材料种类和掺量、含水率和水胶比对其性能的影响规律。结果表明,炭黑掺量10%、水胶比0.6为最佳水泥基材料配合比。同时,对水泥基电池的制备进行了优化试验,以体积能量密度衡量,金属体植入法>金属涂层法>粉末混合法,其中粉末混合法制备方法简单,金属体植入法储存能量多,金属涂层法可进行二次充放电。

The corrosion scenario in human body: Stainless steel 316L orthopaedic implants

As the world’s populations increase and age, there is a parallel increase in the number of medical procedures addressed to bone related injuries. It is estimated that approximately 1 million of orthopaedic implant surgeries in association with total joint replacements are needed every year. This number is expected to double between 1999 and 2025 as a result of increasing numbers of musculoskeletal injuries (i.e., due to routine activities such as work, sport, etc.) and musculoskeletal diseases (i.e., such as osteoporosis, arthritis and bursitis due to increase age). Consequently, the increase demand for better quality of life has necessarily led people to opt for high quality orthopaedic devices for early recovery and speedy resumption of their routine activities. Unfortunately in the present time, it has been found that the current used orthopaedic implants have the tendencies to fail after long period of usage, due to the corrosion issue of implant in the human body. Therefore, this paper provides a simple overview about the corrosion issue of stainless steel (SS) 316L as implants in human body. Electrophoretic deposition (EPD) of hydroxypaptite (HA) bioceramic was proposed as the approach to minimize the corrosion phenomena. Additionally, the corrosion testing of HA coated SS 316L in comparison to pristine SS 316L was also performed and discussed.

深度学习重建联合Smart去金属伪影算法在口腔金属植入物患者头颈CT血管成像中的应用

目的:探讨深度学习重建(DLR)联合Smart去金属伪影(MAR)算法在口腔金属植入物患者头颈CT血管成像(CTA)中的应用价值。方法:选择郑州大学第一附属医院2023年2月至6月口腔有不可拆卸金属植入物行头颈CTA的患者70例,采用以下3种方法重建图像:基于混合模型的自适应迭代重建(ASIR-V)50%算法(IR),ASIR-V50%联合Smart MAR算法(IR-S),高水平DLR联合Smart MAR算法(DLR-S)。测量不受伪影影响的颈内动脉C1段和头夹肌感兴趣区CT值的标准差(SD)2和SD4,作为图像噪声指标;计算颈内动脉C1段和舌部的金属伪影指数(AI)1和AI2;对颈内动脉C1段和口腔整体图像质量进行主观评分。结果:与IR组和IR-S组比较,DLR-S组SD2和SD4降低(P<0.05)。与IR组比较,IR-S组和DLR-S组AI1、AI2降低;与IR-S组比较,DLR-S组AI1、AT2降低(P<0.05)。与IR组比较,IR-S组和DLR-S组口腔整体和颈内动脉C1段图像质量主观评分均增高;与IR-S组比较,DLR-S组图像质量主观评分增高(P<0.05),9例患者舌部可见新的伪影。结论:Smart MAR联合DLR可减少口腔植入物造成的金属伪影,提高头颈CTA图像质量。但Smart MAR可能引入新的伪影,需联合未加入Smart MAR的图像进行分析。

Imaging characteristics of metallic interbody spacers: in vitro score evaluation of susceptibility artifacts considering different MRI sequences

Aim: Intervertebral spacers for anterior spine fusion are made of different materials, such as titanium, carbon or cobalt-chrome, which can affect the post- fusion MRI scans. Implant-related susceptibility artifacts can decrease the quality of MRI scans, thwar- ting proper evaluation. This cadaver study aimed to demonstrate the extent that implant-related MRI artifacting affects the post-fusion evaluation of intervertebral spacers. Methods: In a cadaveric porcine spine, we evaluated the post-implantation MRI scans of 2 metallic intervertebral spacers (TiAL6V4, CoCrMo) that differed in shape, material, surface qualities and implantation technique. A spacer made of human cortical bone was used as a control. The median sagittal MRI slice was divided into 12 regions of interest (ROI). Results: No significant differences were found on 15 different MRI sequences read independently by an interobserver-validated team of specialists (P>0.05). Artifact-affected image quality was rated on a score of 0-1-2. A maximum score of 24 points (100%) was possible. Turbo spin echo sequences produced the best scores for all spacers and the control. Only the control achieved a score of 100%. The titanium and cobalt-chrome spacers scored 62.5% and 50%, respectively. Conclusions: Our scoring system allowed us to create an implant-related rank- ing of MRI scan quality in reference to the control that was independent of artifact dimensions. Even with turbo spin echo sequences, the susceptibility artifacts produced by the metallic spacers showed a high degree of variability. Despite optimum sequen- cing, implant design and material are relevant factors in MRI artifacting.

MRI-Induced Tissue Heating at Metallic Sutures (Cerclages)

Magnetic resonance imaging (MRI) has become an important diagnostic tool with an ongoing dynamic development towards application of increasing static magnetic flux densities and consequently, exposures to electromagnetic fields (EMF) of increasing radio frequencies (RF). This raises particular concern metallic implants could lead to excess tissue heating and consequently, to thermal tissue damage. In thorax surgery the intersected sternum is reconnected by metallic sutures (cerclages). To investigate whether patients with such implants can be accepted for MRI and whether there may be limitations with regard to static magnetic fields, by numerical anatomical and thermal modelling MRI induced tissue heating was assessed for magnetic flux densities 1.5 T, 3 T, 4 T and 7 T. Results show that overall tissue temperature increased with increasing RF EMF frequency. However, even for setting MRI exposure parameters at maximum permissible level partial body heating remained marginally affected and even at local level the additional contribution of the presence of the metallic cerclage remained below 1°C. This allows concluding that from a heating point of view metallic sutures as used to fix the sternum after thorax surgery are no contraindication for MRI with static magnetic flux densities up to 7 T.

Characteristics of La_0.7Sr_0.3MnO₃Films Modified by Aluminum Ions Implantation and Post-Implantation Annealing

The magnetron sputtered La0.7Sr0.3MnO3 films were implanted with different doses (5 ′ 1015 ions×cm?2 and 5 ′ 1016 ions×cm-2) of Al ions at different negative pulsed voltages (30 kV and 50 kV) by plasma based ion implantation and then annealed at 973 K for 1 h in air. The microstructure, surface morphologies, surface roughness, metal-insulator transition and room temperature emittance properties of the post-implantation annealed films were investigated and compared with those of the La0.7Sr0.3MnO3 film annealed at 973 K for 1 h in air. The results indicate that the post- implantation annealed films show single perovskite phase and obvious (100) preferred orientation growth. The Mn-O bond length, surface roughness and metal-insulator transition temperature (TMI) of the films can be effectively adjusted by changing implantation voltage or implantation dose of Al ions. However, the change of implantation parameters just has a small effect on room temperature emittance of the films. Compared with the annealed film, the post-implantation annealed films have shorter Mn-O bond length and lower room temperature emittance. The TMI of the films implanted at low voltage is lower than that of the annealed film, which mainly results from the degradation of oxidization during annealing process and the part displacement of Mn3+-O2+- Mn4+ double exchange channels by Al3+-O2?-Mn4+. The post-implanted annealed film implanted at 50 kV/5 ′ 1016 ions×cm-2 has a higher TMI than the annealed film, which is 247 K. The increase of TMI of the film implanted with high dose of Al ions at high voltage can be attributed to the improvement of microstructure.

Aluminum ion beam surface modification of elastic metallic-plastic pads for improving tribological properties

Elastic metallic-plastic pads（EMP） were irradiated by low energy aluminum ion in a metal vapor vacuum arc（MEVVA） 80-10 implantation system. The samples were irradiated with 20keV Al ion with the influx from 1×1015 to 1×1016 Al/cm2. Then the as-irradiated samples were measured by ESCA, XRD, AFM/FFM and a nano-probe. It is found that the hardness of as-irradiated samples is 5-6 times as that of the pristine ones. The worn depth of sample implanted at ion influx of 1×1016 Al/cm2 is about one eighth of that of the pristine sample at the same load. The XRD results show that there are some Al2O3 and AlF3 intermingled with the phase of polytetrafluoroethylene（PTFE）. The experimental results reveal that the tribological properties of EMP can be significantly improved by the ion beam surface modification.

Development and experimental study of large size composite plasma immersion ion implantation device

Plasma immersion ion implantation （PI） overcomes the direct exposure limit of traditional beam- line ion implantation, and is suitable for the treatment of complex work-piece with large size. Pm technology is often used for surface modification of metal, plastics and ceramics. Based on the requirement of surface modification of large size insulating material, a composite full-directional PHI device based on RF plasma source and metal plasma source is developed in this paper. This device can not only realize gas ion implantation, but also can realize metal ion implantation, and can also realize gas ion mixing with metal ions injection. This device has two metal plasma sources and each metal source contains three cathodes. Under the condition of keeping the vacuum unchanged, the cathode can be switched freely. The volume of the vacuum chamber is about 0.94 m3, and maximum vacuum degree is about 5 x10-4 Pa. The density of RF plasma in homogeneous region is about 109 cm-3, and plasma density in the ion implantation region is about 101x cm-3. This device can be used for large-size sample material PHI treatment, the maximum size of the sample diameter up to 400 mm. The experimental results show that the plasma discharge in the device is stable and can run for a long time. It is suitable for surface treatment of insulating materials.

微弧氧化对金属植入物抗菌和抗炎能力的调节效应

背景:微弧氧化技术能够有效地将生物活性元素掺杂到金属表面,提高生物医用金属材料的抗菌性能和抗炎性能,因此该技术已成为生物医用材料的研究热点之一。目的:重点介绍微弧氧化技术及其与其他表面改性技术联合应用制备植入物表面涂层的抗菌性能和抗炎性能。方法:以“微弧氧化,抗炎性能,抗菌性能,金属植入物”为中文检索词检索中国知网和万方数据库,以“micro-arc oxidation、antibacterial properties,anti-inflammatory properties,metal implants”为英文检索词检索PubMed数据库,检索时间范围为1996年1月至2022年12月,根据纳入和排除标准初筛后,最后保留89篇文献进行归纳总结。结果与结论:微弧氧化陶瓷层提高了钛、镁等合金的抗菌性能和抗炎性能,联合其他表面改性技术有效解决了孔隙对合金表面性能的影响,进一步提高了氧化膜的生物学性能,在骨科和牙科等领域有着广泛的应用前景。目前研究多局限于金属涂层,而且大部分研究集中在银、铜等具有良好抗菌性能的金属元素,仅有少数研究提到氧化石墨烯、羟基磷灰石和壳聚糖等非金属涂层,未来可以对无机物涂层和高分子涂层进行广泛研究,也可采取更多种不同生物活性元素的组合来提高抗菌性能。目前微弧氧化技术所制备的植入体涂层炎症研究多局限于免疫系统,且集中在巨噬细胞,而其对于中性粒细胞、血小板等的研究稀缺,未来需联合应用多种先进技术手段探究微弧氧化涂层对其他免疫细胞和炎症细胞的具体影响。

离子注入诱导成核外延高质量AlN

超宽禁带AlN材料具有禁带宽度大、击穿电场高、热导率高、直接带隙等优势,被广泛应用于光电子器件和电力电子器件等领域.AlN材料的质量影响着AlN基器件的性能,为此研究人员提出了多种方法来提高异质外延AlN晶体的质量,但是这些方法工艺复杂且成本高昂.因此,本文提出了诱导成核的新方法来获得高质量的AlN材料.首先,对纳米图案化的蓝宝石衬底注入不同剂量的N离子进行预处理,随后基于该衬底用金属有机化学气相沉积法外延AlN基板,并在其上生长多量子阱结构,最后基于此多量子阱结构制备紫外发光二极管.研究结果表明,在注入N离子剂量为1×10^(13) cm^(-2)的衬底上外延获得的AlN基板,其表面粗糙度最小且位错密度最低.由此可见,适当剂量的N离子注入促进了AlN异质外延过程中的横向生长与合并过程;这可能是因为N离子的注入,抑制了初期成核过程中形成的扭曲的镶嵌结构,有效地降低了AlN的螺位错以及刃位错密度.此外,基于该基板制备的多量子阱结构,其残余应力最小,光致发光强度提高到无注入样品的152%.此外,紫外发光二极管的光电性能大幅提高,当注入电流为100 mA时,光输出功率和电光转换效率分别提高了63.8%和61.7%.

Interaction pathways of implant metal localized corrosion and macrophage inflammatory reactions

Macrophages play a central role in immunological responses to metallic species associated with the localized corrosion of metallic implants,and mediating in peri-implant inflammations.Herein,the pathways of localized corrosion-macrophage interactions were systematically investigated on 316L stainless steel(SS)implant metals.Electrochemical monitoring under macrophage-mediated inflammatory conditions showed a decreased pitting corrosion resistance of 316L SSs in the presence of RAW264.7 cells as the cells would disrupt biomolecule adsorbed layer on the metal surface.The pitting potentials were furtherly decreased when the RAW264.7 cells were induced to the M1 pro-inflammatory phenotype by the addition of lipopolysaccharide(LPS),and pitting corrosion preferentially initiated at the peripheries of macrophages.The overproduction of aggressive ROS under inflammatory conditions would accelerate the localized corrosion of 316L SS around macrophages.Under pitting corrosion condition,the viability and pro-inflammatory polarization of RAW264.7 cells were region-dependent,lower viability and more remarkable morphology transformation of macrophages in the pitting corrosion region than the pitting-free region.The pitting corrosion of 316L SS induced high expression of CD86,TNF-α,IL-6 and high level of intracellular ROS in macrophages.Uneven release of metallic species(Fe^(2+),Cr^(3+),Ni^(2+),etc)and uneven distribution of surface overpotential stimulated macrophage inflammatory responses near the corrosion pits.A synergetic effect of localized corrosion and macrophages was revealed,which could furtherly promote localized corrosion of 316L SS and macrophage inflammatory reactions.Our results provided direct evidence of corrosion-macrophage interaction in metallic implants and disclosed the pathways of this mutual stimulation effect.

镁金属骨科植入材料的研究进展

镁金属因具有优异的生物相容性、生物可降解性以及力学性能,能够满足骨科植入材料的长期使用要求,近年来逐渐成为骨科新型植入材料的研究热点。此外,随着镁金属植入材料制备工艺的不断完善,通过新型的加工方法、制备技术和表面处理等手段,可以进一步提高其性能,以满足镁金属植入材料在骨科领域的应用需求。尽管镁金属植入物目前在临床应用中还存在一些挑战和问题,如材料的稳定性、降解速率和组织反应等,但随着相关技术的不断成熟和进步,这些问题都可以逐步被解决。该文就镁金属骨科植入材料的骨代谢机制、镁金属在骨植入材料中存在的问题和优化方案以及镁金属植入材料在骨科领域的应用现状3方面进行综述,展望其未来在骨科植入材料中的应用前景。

金属有机框架与种植体表面改性及其应用

背景:近年来,金属有机框架由于其特有性质在生物医学领域应用广泛,可以将金属有机框架应用于种植体表面改性,以改善其生物学性能,提高手术成功率。目的:介绍种植体表面改性领域常用的金属有机框架以及种植体表面金属有机框架改性的制备和作用机制。方法:采用计算机检索中国知网、PubMed和Web of Science数据库中有关金属有机框架应用于种植体表面改性的研究资料,选取发表于2010-2023年的相关文献,最终纳入64篇文献进行综述分析。结果与结论:①金属有机框架具有孔隙率高、比表面积大及空间结构多样等性质,作为一种生物活性材料,金属有机框架在组织工程和再生医学中逐渐引起重视。②种植体改性领域常用的金属有机框架类型主要有3种:类沸石骨架材料最常作为载体应用,负载各种药物和生物分子,MIL系列材料适用于药物载体和纳米酶,Bio-金属有机框架因结构多样而应用广泛,突出特点是优异的生物安全性。③金属有机框架改性的种植体材料制备方法大致分为两类,第一类是将已合成的金属有机框架结合到预处理植入材料上,第二类是在预处理的材料表面原位合成金属有机框架。④种植体表面的金属有机框架通过降解释放自身组分、负载药物、催化活性反应及与其他材料联合等多种机制,赋予种植体抗菌抗炎促进骨整合的特性,但金属有机框架涂层制备方法还需要进一步完善,同时应深入探究材料后续代谢和分布问题,积极推动其在临床上的应用。

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

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。