应用自膨胀金属支架治疗梗阻性结直肠癌25例的疗效观察

doi:10.3877/cma.j.issn.1674-3946.2020.05.012

目的

探讨肠镜下自膨胀金属支架(SEMS)置入序贯手术与急诊手术(ES)在梗阻性结直肠癌患者的治疗效果。

方法

回顾性分析2014年至2019年接受手术治疗的梗阻性结直肠癌患者55例，其中SEMS组25例，术前接受肠道支架置入，梗阻解除后1周左右行根治性切除；ES组30例接受急诊手术治疗。采用SPSS24.0统计软件处理和分析数据。术中术后各项指标采用(±s)表示，独立t检验；术后并发症、肿瘤根治性切除率等采用χ²检验。P<0.05为有统计学意义。

结果

原发肿瘤根治性切除：ES组22例(73.3%)明显低于SEMS组25例(100%); ES组切除淋巴结为(9.6±5.5)个明显低于SEMS组(18.7±7.7)个；一期手术造口：ES组26例(86.7%)，SEMS组11例(44.0%)；造口还纳率ES组38.4%，SEMS组90.9%；永久性造瘘率ES组16例(53.3%)，SEMS组1例(4.0%)；手术切口感染：ES组4例(13.3%)，SEMS组0例(0.0%)，上述各项指标两组差异均有统计学意义(P<0.05)。

结论

肠镜下放置SEMS，然后序贯手术治疗结直肠癌梗阻是安全、有效的备选治疗方案之一。

关键词: 结直肠肿瘤, 肠梗阻, 自膨胀金属支架

Objective

To investigate the curative effect of self-expandable metal stents (SEMS) in the preoperative management of acute obstructive colorectal cancer.

Methods

A retrospective analysis was performed in 55 patients with obstructive colorectal cancer who underwent surgery from 2014 to 2019, including 25 cases in the SEMS group received peroperative implantation of SEMS and underwent selective surgery 1 week later, while 30 cases in ES group received emergency surgery. Statistical analysis were performed by using SPSS24.0 software. Intraoperative and postoperative indexes were expressed as (±s), and were examined by using independent t test. Count data such as postoperative complications and radical resection rate of tumor were tested by using χ² test. A P value of <0.05 was considered as statistically significant difference.

Results

In terms of radical resection of the primary tumor, there were 22 patients (73.3%) in the ES group which were significantly lower than 25 patients (100%) in the SEMS group. In terms of harvested lymph nodes, there were (9.6±5.5) in the ES group which was significantly lower than (18.7±7.7) in the SEMS group. In terms of incidence of colostomy in primary surgery, there was 26 cases (86.7%) in the ES group and 11 cases (44.0%) in the SEMS group. The Colostomy closure rate was 38.4% in the ES group and 90.9% in the SEMS group. The permanent colostomy rate was 53.3% (16/30 cases) in the ES group and 4.0% in the SEMS group (1/25 cases). There were 4 cases (13.3%) of surgical incision infection in the ES group, while 0 cases (0.0%) in the SEMS group, with significant difference (P<0.05).

Conclusion

It is a safe and effective treatment to use SEMS as peroperative management of acute obstructive colorectal cancer.

Key words: Colorectal neoplasms, Intestinal obstruction, Self-expandable metal stent

表1 55例不同方式治疗梗阻性结直肠癌患者两组一般情况比较

组别	例	年龄(岁)	性别	糖尿病史	CEA(ng/ml)
组别	例	年龄(岁)	男/女	有/无	CEA(ng/ml)
ES组	30	69.6±10.5	20/10	10/20	10.0(2.9～490.8)
SEMS组	25	70.6±9.6	15/10	5/20	6.6(1.0～1232.0)
P值	?	0.367	0.939	0.590	0.242
组别	例	肿瘤位置
组别	例	横结肠/降结肠/乙状结肠/直乙交界
ES组	30	0/8/16/6
SEMS组	25	2/6/14/3
P值	?	0.366

表1 55例不同方式治疗梗阻性结直肠癌患者两组一般情况比较

组别	例	年龄(岁)	性别	糖尿病史	CEA(ng/ml)
组别	例	年龄(岁)	男/女	有/无	CEA(ng/ml)
ES组	30	69.6±10.5	20/10	10/20	10.0(2.9～490.8)
SEMS组	25	70.6±9.6	15/10	5/20	6.6(1.0～1232.0)
P值	?	0.367	0.939	0.590	0.242
组别	例	肿瘤位置
组别	例	横结肠/降结肠/乙状结肠/直乙交界
ES组	30	0/8/16/6
SEMS组	25	2/6/14/3
P值	?	0.366

表2 55例不同术式治疗梗阻性结直肠癌患者术中术后各项指标比较[(±s)，例]

组别	例	手术方式	手术时间(min)	术中出血量(ml)	进食时间(d)
组别	例	A/B/C/D	手术时间(min)	术中出血量(ml)	进食时间(d)
ES组	30	8/8/10/4	205±52.7	250±50.7	4.2±2.1
SEMS组	25	0/2/9/14	200±71.6	102±62.8	3.7±2.1
P值	?	0.590	0.055	0.009	0.412
组别	例	术后住院时间(d)	造口还纳手术入路[例(%)]	腔镜/开腹[例(%)]
ES组	30	16.2±4.7	10/26(38.4)	2(6.7)/28(93.3)
SEMS组	25	14.6±5.2	10/11(90.9)	18(76.9)/7(23.1)
P值	?	0.503	0.001	<0.01

表2 55例不同术式治疗梗阻性结直肠癌患者术中术后各项指标比较[(±s)，例]

组别	例	手术方式	手术时间(min)	术中出血量(ml)	进食时间(d)
组别	例	A/B/C/D	手术时间(min)	术中出血量(ml)	进食时间(d)
ES组	30	8/8/10/4	205±52.7	250±50.7	4.2±2.1
SEMS组	25	0/2/9/14	200±71.6	102±62.8	3.7±2.1
P值	?	0.590	0.055	0.009	0.412
组别	例	术后住院时间(d)	造口还纳手术入路[例(%)]	腔镜/开腹[例(%)]
ES组	30	16.2±4.7	10/26(38.4)	2(6.7)/28(93.3)
SEMS组	25	14.6±5.2	10/11(90.9)	18(76.9)/7(23.1)
P值	?	0.503	0.001	<0.01

表3 55例不同术式治疗梗阻性结直肠癌患者两组术后病理比较(例)

组别	例	组织学类型	病理分期	淋巴结个数(±s)
组别	例	A/B/C	Ⅱ/Ⅲ/Ⅳ	淋巴结个数(±s)
ES组	30	10/12/8	12/13/5	9.6±5.5
SEMS组	25	8/12/5	13/8/4	18.7±7.7
P值	?	0.066	0.441	<0.01

表3 55例不同术式治疗梗阻性结直肠癌患者两组术后病理比较(例)

组别	例	组织学类型	病理分期	淋巴结个数(±s)
组别	例	A/B/C	Ⅱ/Ⅲ/Ⅳ	淋巴结个数(±s)
ES组	30	10/12/8	12/13/5	9.6±5.5
SEMS组	25	8/12/5	13/8/4	18.7±7.7
P值	?	0.066	0.441	<0.01

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Clinical application of self-expandable metal stents in the preoperative management of acute obstructive colorectal cancer, report of 25 cases

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Clinical application of self-expandable metal stents in the preoperative management of acute obstructive colorectal cancer, report of 25 cases