Effect of nutritional support + intravenous chemotherapy on anti-tumor immunity and cancer cell proliferation in patients with colon cancer complicated by incomplete intestinal obstruction

Objective:To study the effect of nutritional support + intravenous chemotherapy on anti-tumor immunity and cancer cell proliferation in patients with colon cancer complicated by incomplete intestinal obstruction.Methods: Patients with colon cancer complicated by incomplete intestinal obstruction who were treated in Midi Branch, Pangang Group General Hospital between March 2015 and October 2017 were selected and randomly divided into the nutrition group who accepted nutritional support + FOLFOX4 intravenous chemotherapy and the control group who accepted FOLFOX4 intravenous chemotherapy alone, and they underwent surgery after two cycles of chemotherapy. The contents of immune cells in peripheral blood and the contents of immune cytokines in serum were determined before chemotherapy and two cycles after chemotherapy;the expression levels of proliferation genes in colon cancer lesions were determined after surgical resection.Results:Compared with those of same group before chemotherapy, peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of nutrition group were decreased significantly after chemotherapywhereas peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of control group did not change significantly after chemotherapy, and compared with those after chemotherapy between groups, peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of nutrition group were significantly lower than those of control group, and CyclinD1, Bcl-2, USP22, VEGF and N-cadherin mRNA expression were not different from those of control group.Conclusion:Nutritional support + intravenous chemotherapy can improve the anti-tumor immune response without affecting the proliferation of cancer cells in the lesion of patients with colon cancer complicated by incomplete intestinal obstruction.

Colonic stenting vs emergent surgery for acute left-sided malignant colonic obstruction:A systematic review and meta-analysis

AIM:To investigate the effects of emergent preopera-tive self-expandable metallic stent (SEMS) vs emer-gent surgery for acute left-sided malignant colonic obstruction. METHODS:Two investigators independently searched the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, as well as references of included studies to identify randomized controlled trials (RCTs) that compared two or more surgical approaches for acute colonic obstruction. Summary risk ratios (RR) and 95% CI for colonic stenting and emergent surgery were calculated. RESULTS:Eight studies met the selection criteria, involving 444 patients, of whom 219 underwent SEMS and 225 underwent emergent surgery. Seven studies reported difference of the one-stage stoma rates between the two groups (RR, 0.60; 95% CI:0.48-0.76; P < 0.0001). Only three RCTs described the follow-up stoma rates, which showed no significant difference between the two groups (RR, 0.80; 95% CI:0.59-1.08; P = 0.14). Difference was not significant in the mortality between the two groups (RR, 0.91; 95% CI:0.50-1.66; P = 0.77), but there was significant difference (RR, 0.57; 95% CI:0.44-0.74; P < 0.0001) in the overall morbidity. There were no significant differences between the two groups in the anastomotic leak rate (RR, 0.60; 95% CI: 0.28-1.28; P = 0.19), occurrence of abscesses, including peristomal abscess, intraperitoneal abscess and parietal abscess (RR, 0.83; 95% CI:0.36-1.95; P = 0.68), and other abdominal complications (RR: 0.67; 95% CI: 0.40-1.12; P = 0.13). CONCLUSION:SEMS is not obviously more advantageous than emergent surgery for patients with acute left-sided malignant colonic obstruction.

Acute colonic pseudo-obstruction: A systematic review of aetiology and mechanisms

AIM To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction(ACPO).METHODS A systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO. A narrative synthesis of the evidence was undertaken. RESULTS No consistent approach to the definition or reporting of ACPO has been developed, which has led to overlapping investigation with other conditions. A vast array of risk factors has been identified, supporting a multifactorial aetiology. The pathophysiological mechanisms remain unclear, but are likely related to altered autonomic regulation of colonic motility, in the setting of other predisposing factors. CONCLUSION Future research should aim to establish a clear and consistent definition of ACPO, and elucidate the pathophysiological mechanisms leading to altered colonic function. An improved understanding of the aetiology of ACPO may facilitate the development of targeted strategies for its prevention and treatment.

Long-term outcome of indwelling colon observed seven years after radical resection for rectosigmoid cancer: A case report

BACKGROUND Indwelling colon is characterized by an excluded segment of the colon after surgical diversion of the fecal stream with colostomy so that contents are unable to pass through this part of the colon.We report a rare case of purulent colonic necrosis that occurred 7 years after surgical colonic exclusion.CASE SUMMARY A 73-year-old male had undergone extended radical resection for rectosigmoid cancer.The invaded ileocecal area and sigmoid colon were removed during the procedure,and the ileum was anastomosed side-to-side with the rectum.The excluded ascending,transverse,and descending colon were sealed at both ends and left in the abdomen.After 7 years,the patient developed persistent abdominal pain and distension.Work-up indicated intestinal obstruction.The patient underwent ultrasound-guided catheter drainage of the descending colon and a large amount of viscous liquid was drained,but the symptoms persisted;therefore,surgery was planned.Intraoperatively,extensive adhesions were found in the abdominal cavity,and the small intestine and the indwelling colon were widely dilated.The dilated colon was 56 cm long,5 cm wide(diameter),and contained about 1500 mL of viscous liquid.The indwelling colon was surgically removed and its histopathological examination revealed colonic congestion and necrosis with hyperplasia of granulation tissue.The bacterial culture of the secretions was negative.The patient recovered after the operation.CONCLUSION Although colonic exclusion is routinely performed,this report aimed to increase awareness regarding the possible long-term complications of indwelling colon.

Oncologic safety of colonic stenting as a bridge to surgery in leftsided malignant colonic obstruction:Current evidence and prospects

Approximately 7%-29%of patients with colorectal cancer present with colonic obstruction.The concept of self-expandable metal stent(SEMS)insertion as a bridge to surgery(BTS)is appealing.However,concerns on colonic stenting possibly impairing oncologic outcomes have been raised.This study aimed to review current evidence on the short-and long-term oncologic outcomes of SEMS insertion as BTS for left-sided malignant colonic obstruction.For short-term outcomes,colonic stenting facilitates a laparoscopic approach,increases the likelihood of primary anastomosis without a stoma,and may decrease postoperative morbidity.However,SEMS-related perforation also increases local recurrence and impairs overall survival.Moreover,colonic stenting may cause negative oncologic outcomes even without perforation.SEMS can induce shear forces on the tumor,leading to increased circulating cancer cells and aggressive pathological characteristics,including perineural and lymphovascular invasion.The conflicting evidence has led to discordant guidelines.Well-designed collaborative studies that integrate both oncologic outcomes and data on basic research(e.g.,alteration of circulating tumors)are needed to clarify the actual benefit of colonic stenting as BTS.

Role of self-expanding metal stents in patients with malignant colorectal obstruction: A systematic review and meta-analysis

AIM: To assess the safety and efficacy of self-expandable metal stents(SEMSs) for malignant colorectal obstruction. METHODS: Data regarding technical success, clinical success, and procedure related complications were collected from included studies. Der Simonian-Laird random effects model was used to generate the overall outcome. Thirty international studies with a total of 2058 patients with malignant colorectal obstruction were included. RESULTS: The technical and clinical success rates for SEMS placement were 94%(95%CI: 92-96) and 91%(95%CI: 88-93), respectively. Overall complication rate for SEMS was 23%(95%CI: 18-29). Stent migration8%(95%CI: 6-10) and stent obstruction 8%(95%CI: 6-11) were the most common complications, followed by perforation 5%(95%CI: 4%-7%). Surgical or endoscopic re-interventions were needed in 14%(95%CI: 10-18) of patients. Endoscopic repeat stent placement was required in 8%(95%CI: 6-10), while surgical intervention was needed in 6%(95%CI: 4-8).CONCLUSION: SEMS are effective when used as palliation or bridge to surgery for malignant colorectal obstruction with high technical and clinical success. About 14% of patients require repeat endoscopic or surgical intervention for stent failure or to manage stent related complications.

Effects of alanine glutamine on inflammatory, immune, antioxidant and nutritional indicators in colon cancer patients

Objective:To explore the effects of alanine glutamine on inflammatory, immune, antioxidant and nutritional indicators in colon cancer patients.Methods: A total of 126 cases of colon cancer with intestinal obstruction were divided into control group (n=63) and observation group (n=63) from May 2015 to May 2017 in Zhongnan Hospital of Wuhan University and Gezhouba Dam group central hospital, the control group only received parenteral nutrition, while the observation group was treated with parenteral nutrition plus alanine glutamine treatment. The expression levels of nutritional indicators, inflammatory factors, immunity and antioxidant were compared between the two groups.Results:Before and 1 d after treatment, there was no significant difference between the two groups of prealbumin (PA), albumin (ALB), tumor necrosis factor-α (TNF-α), C reactive protein (CRP), interferon-γ (IFN-γ) and immunoglobulin (IgA, IgG, IgM), superoxide dismutase (SOD) and malondialdehyde (MDA). 1 d after treatment, the levels of PA, ALB, IFN-γ, IgA, IgG, IgM and SOD in two groups were significantly lower than before the treatment, and TNF- , CRP and MDA were significantly higher than before the treatment. On the 7 d after treatment, the levels of PA, ALB, IFN-γ, IgA, IgG, IgM and SOD in two groups were significantly increased compared with the 1 d after treatment, while TNF-α, CRP and MDA were significantly lower than the 1 d after the treatment, the PA, ALB, IFN-γ, IgA, IgG, IgM and SOD levels in the observation group were significantly higher than those in the control group, while TNF-α, CRP and MDA were significantly lower than those of the control group, there was no significant difference in IgA, IgG and IgM levels between the observation group and that before treatment. There was no significant difference in MDA and SOD levels between the control group and that before tre atment.Conclusions: Parenteral nutrition support in patients with colon cancer with intestinal obstruction, alamyl glutamine, can significantly improve the nutritional level, reduce the inflammatory response, enhance the immune and antioxidant functions.

急诊手术与支架扩张后择期手术治疗右半结肠癌合并急性肠梗阻患者效果的比较

目的比较急诊手术与支架扩张后择期手术治疗右半结肠癌合并急性肠梗阻患者的效果。方法根据治疗方式的不同将96例右半结肠癌合并急性肠梗阻患者分为对照组(n=46,急诊手术)和观察组(n=50,支架扩张后择期手术),比较两组患者的围手术期指标、胃肠激素指标[胃动素(MTL)、胃泌素(GAS)、血管活性肠肽(VIP)]、炎性因子指标[白细胞介素(IL)-6、IL-8、肿瘤坏死因子-α(TNF-α)]、术后并发症发生情况及生存情况。结果观察组患者术中出血量少于对照组,首次肛门排气时间、流质饮食恢复时间、术后住院时间均短于对照组,淋巴结清扫数目多于对照组,差异均有统计学意义(P﹤0.05)。手术后,两组患者MTL、GAS、VIP、IL-6、IL-8、TNF-α水平均低于本组手术前,观察组患者MTL、GAS、VIP水平均高于对照组,IL-6、IL-8、TNF-α水平均低于对照组,差异均有统计学意义(P﹤0.05)。观察组患者的术后并发症总发生率低于对照组,3年生存率高于对照组,差异均有统计学意义(P﹤0.05)。结论与急诊手术比较,支架扩张后择期手术治疗右半结肠癌合并急性肠梗阻患者,可以减少术中出血量,增加淋巴结清扫数目,促进术后恢复,降低胃肠激素和炎性因子水平,减少术后并发症,提高术后生存率。

Enteral stents for the management of malignant colorectal obstruction

Colorectal cancer(CRC) is the 3rd most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient's quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may beused to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient's condition for curative surgical intervention. An overall complication rate(major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.

Malignant obstruction in the ileocecal region treated by selfexpandable stent placement under the fluoroscopic guidance: A case report

BACKGROUND Malignant tumors of the ileocecal region often cause intestinal obstruction.Emergency surgery is the main treatment for patients presenting with an obstruction.However,this procedure is associated with a high mortality rate and frequent complications.The placement of colon stents is commonly performed for obstructions in the distal colon and is a less invasive and safer procedure.However,obstructions in the proximal colon are more challenging to treat by stent placement due to the increased distance from the anus.CASE SUMMARY This case report concerns an 88-year-old man with malignant intestinal obstruction in the ileocecal region.He was contraindicated for general anesthesia and surgical enterostomy.The placement of a self-expandable metallic stent seems an alternative to surgery,although stenting in this area is thought to be difficult and few studies have been reported so far.After three attempts at different interventional approaches,a stent was successfully placed in the obstructed segment under fluoroscopic guidance.After the procedure,the patient's abdominal distension and abdominal pain were significantly better than before.CONCLUSION For patients with proximal colonic obstruction,self-expandable metallic stent placement under fluoroscopic guidance could be considered as a feasible treatment to relieve abdominal distension and pain in patients with acute bowel obstruction.It has the characteristics of high safety and high patient tolerance.However,further study is still needed.

腹腔镜下结直肠癌根治术治疗老年结直肠癌并急性肠梗阻患者的临床疗效分析

目的分析腹腔镜下结直肠癌根治术治疗老年结直肠癌并急性肠梗阻患者的临床疗效。方法方便选取2020年1月—2022年1月莱州市人民医院胃肠外科收治的98例结直肠癌并急性肠梗阻患者作为研究对象。根据患者采用的手术术式分为观察组与对照组,各49例。对照组行传统开腹结直肠癌根治术,观察组行腹腔镜下结直肠癌根治术。比较两组治疗效果,术中出血量、手术实施时间、淋巴结清扫数、切口长度,保肛率、术后通气时间、术后住院天数、术后进食时间、引流管留置时间、留置尿管时间,胃动素和胃泌素水平,术后并发症发生率。结果观察组有效率为87.76%(43/49)高于对照组的69.39%(34/49),差异有统计学意义(χ^(2)=4.909,P=0.027)。两组患者手术实施时间、淋巴结清扫数、术后保肛率、引流管留置时间、留置尿管时间比较,差异无统计学意义(P>0.05);观察组术中出血量、术后通气时间、切口长度、术后住院天数、术后进食时间均低于对照组,差异有统计学意义(P<0.05)。治疗前,两组胃动素、胃泌素水平比较,差异无统计学意义(P>0.05);治疗后,两组胃动素、胃泌素水平均下降,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组的术后并发症发生率为10.20%,明显低于对照组的36.73%,差异有统计学意义(χ^(2)=9.601,P=0.002)。结论在老年结直肠癌并急性肠梗阻患者中行腹腔镜下结直肠癌根治术能取得更好的治疗效果,且患者术后恢复更快、并发症发生率更低。

完全腹腔镜右半结肠切除术联合腹腔热灌注化疗后延迟性肠麻痹危险因素分析与风险预测模型构建

目的 探讨结肠癌患者行完全腹腔镜右半结肠切除术联合腹腔热灌注化疗后延迟性术后肠麻痹(Prolonged postoperative ileus, PPOI)的危险因素并建立风险预测模型。方法 回顾性分析2018年1月—2022年1月在解放军总医院第一医学中心普通外科医学部行完全腹腔镜右半结肠切除术联合腹腔热灌注化疗的83例结肠癌患者的病例资料,统计PPOI的发生情况,分析其危险因素,并构建列线图风险预测模型及进行效能验证。结果 83例患者中有26例(31.3%)发生PPOI。多因素logistic回归分析结果显示,合并糖尿病(OR=14.820,95%CI:2.819~77.918)、既往腹部手术史(OR=6.514,95%CI:1.433~29.604)、术前血红蛋白<9 g/L(OR=5.338,95%CI:1.197~23.809)、术中出血超过200 mL(OR=4.869,95%CI:1.213~19.544)以及未关闭系膜裂孔(OR=5.462,95%CI:1.408~21.186)为PPOI发生的独立危险因素。依据多因素分析结果构建ROC曲线及PPOI列线图风险预测模型,内部验证一致性指数(C-index)为0.85(95%CI:0.735~0.957)。结论 合并糖尿病、既往腹部手术史、术前血红蛋白<9 g/L、术中出血超过200 mL以及未关闭系膜裂孔是完全腹腔镜右半结肠切除术联合腹腔热灌注化疗后发生PPOI的危险因素。构建的完全腹腔镜右半结肠切除术后发生PPOI的列线图风险预测模型具有良好的评价效果和临床应用价值。

肠黏膜紧密连接蛋白变化与结肠癌合并肠梗阻患者发生细菌移位的相关性研究

目的:分析肠黏膜紧密连接(tight junction,TJ)蛋白变化与结肠癌合并肠梗阻发生细菌移位(bacterial translocation,BT)的相关性。方法:回顾性分析2020年10月-2022年6月萍乡市人民医院80例行结肠癌治疗的患者的临床资料,根据患者是否合并肠梗阻分为肠梗阻组(n=30)和非肠梗阻组(n=50),比较两组BT发生率。将肠梗阻组BT患者分为BT阳性组与BT阴性组,比较两组TJ蛋白[咬合蛋白(Occludin)、闭合蛋白-1(Claudin-1)、闭合蛋白-4(Claudin-4)及胞质紧密黏连蛋白-1(ZO-1)]的表达。结果:肠梗阻组BT发生率为56.67%(17/30),高于非肠梗阻组BT发生率18.00%(9/50),差异有统计学意义(P<0.05)。BT阳性组肠黏膜组织中Occludin、ZO-1蛋白表达量均低于BT阴性组,Claudin-1、Claudin-4蛋白表达量均高于BT阴性组,差异均有统计学意义(P<0.05)。结论:肠黏膜TJ蛋白表达的变化与结肠癌合并肠梗阻患者BT紧密相关,发生BT的患者Occludin、ZO-1蛋白较低,Claudin-1、Claudin-4较高。

左半结肠癌合并急性肠梗阻肠减压后腹腔镜辅助Ⅰ期切除吻合术效果

目的 探讨左半结肠癌合并急性肠梗阻肠减压后腹腔镜辅助Ⅰ期切除吻合术的临床疗效及安全性。方法 选取2015-06至2021-11解放军总医院第三医学中心收治的左半结肠癌合并急性肠梗阻患者66例,根据治疗方法不同分为两组,对照组(33例)采用Ⅰ期切除吻合术治疗,研究组(33例)采用肠减压后腹腔镜辅助Ⅰ期切除吻合术治疗,分析两组临床疗效,对比手术及术后效果相关指标,检测炎症因子指标,记录并发症发生情况,评估患者生活质量。结果 研究组总有效率(100.00%)高于对照组(84.85%)(P<0.05)。研究组患者的淋巴结清除数量(12.34±1.34)多于对照组(11.21±1.08),胃肠功能恢复时间[(3.40±0.66)d]、下床活动时间[(41.53±4.30)h]及住院时间[(18.31±3.69)d]均短于对照组[(5.49±0.95)d,(46.28±3.53)h,(26.60±3.13)d](P<0.05)。两组血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)较术前均明显降低,且术后1周研究组TNF-α[(19.18±1.90)pg/ml]、CRP[(30.95±4.00)mg/L]明显低于对照组(P<0.05)。研究组并发症总发生率(9.09%)低于对照组(30.30%)(P<0.05)。研究组患者的躯体功能、心理功能、物质生活以及社会功能评分均明显高于对照组(P<0.05)。结论 肠减压后腹腔镜辅助Ⅰ期切除吻合术可有效提高左半结肠癌合并急性肠梗阻患者的临床疗效,并能促进胃肠功能恢复,缩短住院时间,改善生活质量,且安全性较高。

2D腹腔镜手术治疗结肠癌肠梗阻的疗效及对患者炎症指标的影响分析

目的评估2D腹腔镜手术治疗结肠癌肠梗阻的效果和对患者炎症指标的影响。方法30例结肠癌肠梗阻患者,根据手术的适应证不同分为观察组和对照组,各15例。观察组进行2D腹腔镜手术治疗,对照组进行开腹手术治疗。比较两组临床相关指标、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)水平。结果观察组术中出血量(106.2±25.8)ml少于对照组的(170.4±39.5)ml,切口长度(8.3±2.0)cm、术后排气时间(19.6±8.2)h、住院时间(6.2±1.5)d均短于对照组的(12.9±3.8)cm、(37.6±14.2)h、(9.5±2.0)d,差异均有统计学意义(P<0.05)。两组手术时间比较差异无统计学意义(P>0.05)。观察组TNF-α(39.6±9.8)pg/ml、IL-6(45.3±15.0)pg/ml、IL-10(189.3±35.8)pg/ml、CRP(39.71±13.85)mg/L均低于对照组的(50.2±11.4)pg/ml、(64.9±20.5)pg/ml、(281.6±60.3)pg/ml、(53.98±21.77)mg/L,差异有统计学意义(P<0.05)。结论对结肠癌肠梗阻进行2D腹腔镜手术治疗,其效果和开腹手术相同,但患者的功能修复更迅速,炎性症状缓解快。

肠道金属支架联合肠内-肠外营养对结肠癌伴肠梗阻的应用效果分析

目的分析肠道金属支架联合肠内-肠外营养对结肠癌伴肠梗阻的应用效果。方法选取2019年3月至2022年3月首都医科大学附属北京友谊医院收治的86例结肠癌伴肠梗阻患者,以简单随机法分别纳入联合组和对照组,每组各43例。两组患者均接受肠道金属支架置入治疗,对照组患者接受肠外营养支持,联合组患者接受肠内-肠外联合营养支持。对比两组患者支架置入成功率、梗阻缓解率、支架置入相关并发症发生率、肠功能恢复时间、住院天数及费用,以及术前1 d和术后7 d营养指标、炎性指标变化。结果两组患者支架均成功置入,梗阻缓解率组间比较差异无统计学意义(P>0.05)。联合组患者支架置入相关并发症发生率、住院费用均显著低于对照组(均P<0.05),首次排气时间、首次排便时间均显著早于对照组(均P<0.05),住院天数显著短于对照组(P<0.05)。术后7 d,两组患者血白蛋白(albumin,Alb)、前白蛋白(prealbumin,PA)、血红蛋白(hemoglobin,Hb)水平均显著高于本组术前1 d(均P<0.05),肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-6(interleukin-6,IL-6)、白介素-10(interleukin,IL-10)和C反应蛋白(C-reactive protein,CRP)水平均显著低于本组术前1 d(均P<0.05)。术后7 d,联合组患者Alb、PA、Hb水平均显著高于对照组(均P<0.05),TNF-α、IL-6、IL-10、CRP水平均显著低于对照组(均P<0.05)。结论与肠外营养相比,肠内-肠外联合营养支持能够降低结肠癌伴肠梗阻患者肠道金属支架置入术后并发症发生率、促进胃肠功能恢复、缩短住院天数、降低住院费用,且对于患者营养状况、炎症状态的改善也有积极作用。

大肠癌急性肠梗阻导管植入后患者不良反应及疗效分析

目的观察大肠癌急性肠梗阻患者临床治疗过程中肠梗阻导管植入的疗效与安全性。方法选择2019年5月至2022年5月手术治疗的大肠癌急性肠梗阻患者54例,按照对患者采取的治疗方式分为内镜组(予以内镜支架植入治疗)和导管组(予以肠梗阻导管植入治疗),每组27例。观察2组肠梗阻缓解优良率、治疗后不良反应,记录2组治疗相关指标,治疗前后比较2组腹围、KPS评分、白介素-8(IL-8)与降钙素原(PCT)水平。结果导管组患者肠梗阻缓解优良率高于内镜组(P<0.05);导管组手术时间、腹部胀痛缓解时间、拔管时间、排气时间、总住院时间短于内镜组(P<0.05);导管组腹围明显小于内镜组,KPS卡氏评分高于内镜组(P<0.05);导管组IL-8、PCT水平低于内镜组(P<0.05);导管组总不良反应低于内镜组(P<0.05)。结论肠梗阻导管植入治疗效果、安全性较内镜支架植入更佳,可显著缩小腹围,加速症状消退,下调IL-8、PCT水平,促进功能恢复。

肠造口术与肠道支架置入术后择期手术治疗梗阻性左半结肠癌的效果

目的:比较肠造口术与肠道支架置入术后择期手术治疗梗阻性左半结肠癌的效果。方法:回顾性分析2017年1月—2021年12月莆田市第一医院收治的90例梗阻性左半结肠癌患者的临床资料。根据解除结肠梗阻方式的不同将其分为造口组(n=42)和支架组(n=48)。造口组给予肠造口术,支架组给予肠道支架置入术。比较两组根治性手术情况、并发症、预后情况。结果:造口组术前等待时间、手术时间长于支架组,术后肠造口占比高于支架组,差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。90例患者术后随访时间13~72个月,中位随访时间39.6个月;支架组术后随访期内支架组局部复发与远处转移率显著高于造口组,差异有统计学意义(P<0.05)。随访期内造口组与支架组分别有9例和18例患者死亡,两组生存率(78.57%vs 62.50%)比较,差异无统计学意义(χ^(2)=2.774,P>0.05)。结论:梗阻性左半结肠癌的治疗中,肠道支架置入术后择期手术的短期效果优于肠造口术,但其可能增加术后肿瘤复发、转移发生率,影响远期治疗效果。

老年结肠癌合并肠梗阻的手术时机选择及安全性分析

目的探究老年结肠癌合并肠梗阻的手术时机选择及安全性。方法选取2019年8月至2021年3月于本院治疗的86例结肠癌合并肠梗阻患者作为研究对象,随机分为对照组与观察组,每组43例。观察组给予择期手术,对照组给予急诊手术,比较两组围手术期指标,生命质量评分及并发症发生情况。结果观察组术中出血量少于对照组,胃功能恢复时间、下床活动时间均短于对照组,差异有统计学意义(P<0.05)。观察组生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、精神健康评分均高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为4.65%,低于对照组的20.93%,差异有统计学意义(P<0.05)。结论老年结肠癌合并肠梗阻患者择期进行手术疗效确切,术后并发症发生率较低,可提高生命质量,安全性较高。

支架置入辅助腹腔镜微创手术治疗左半结肠癌伴肠梗阻的效果分析

目的探究支架置入辅助腹腔镜微创手术治疗左半结肠癌伴肠梗阻的临床疗效。方法选取2019年11月至2020年11月本院收治的80例左半结肠癌伴肠梗阻患者作为研究对象,按照随机抽签法分为两组,每组40例。对照组行单纯急诊开腹手术,观察组行支架置入辅助腹腔镜微创手术,比较两组临床疗效、围手术期指标及并发症发生情况。结果观察组治疗总有效率(87.5%)高于对照组(70.0%),差异有统计学意义(P<0.05)。观察组手术时间、术后肛门排气时间、住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率(10.0%)低于对照组(27.5%),差异有统计学意义(P<0.05)。结论支架置入辅助腹腔镜微创手术治疗左半结肠癌伴肠梗阻患者效果显著,可缩短手术时间,减少并发症的发生,安全性、有效性较高,值得临床推广应用。