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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 430 -433. doi: 10.3877/cma.j.issn.1674-3946.2021.04.021

论著

可扩张支架置入联合新辅助化疗后行择期左半结肠根治术治疗梗阻性左半结肠癌
程思俊1, 杨驭媒2, 袁波1, 卢建利3, 邓超4,†()   
  1. 1. 610051　成都，成都市第六人民医院沙河院区胃肠外科
    2. 610051　成都，成都市第六人民医院沙河院区检验科
    3. 610041　成都，三六三医院肝胆胰外科
    4. 643000　四川自贡，自贡市第一人民医院普外科
  • 收稿日期:2020-08-04 出版日期:2021-08-17
  • 通信作者: 邓超

Selective left hemicolectomy after expandable stent placement to relieve obstruction combined with neoadjuvant chemotherapy in the treatment of obstructive left colon cancer

Sijun Cheng1, Yumei Yang2, Bo Yuan1, Jianli Lu3, Chao Deng4,†()   

  1. 1. Gastrointestinal Surgery, Shahe Hospital, Chengdu Sixth People’s Hospital Chengdu, sichuan 610051, China
    2. Clinical Laboratory of Chengdu Sixth People’s Hospital Chengdu, sichuan 610051, China
    3. Department of Hepatobiliary and pancreatic Surgery, 363 Hospital Chengdu, sichuan 610041, China
    4. General Surgery Department, Zigong First People’s Hospital Sichuan zigong 643000, China
  • Received:2020-08-04 Published:2021-08-17
  • Corresponding author: Chao Deng
  • Supported by:
    Scientific Research Project of Sichuan Health Commission-Key Research Projects(19ZD032); Application Foundation Project of Sichuan Science and Technology Department(2019YJ0133)
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程思俊, 杨驭媒, 袁波, 卢建利, 邓超. 可扩张支架置入联合新辅助化疗后行择期左半结肠根治术治疗梗阻性左半结肠癌[J]. 中华普外科手术学杂志(电子版), 2021, 15(04): 430-433.

Sijun Cheng, Yumei Yang, Bo Yuan, Jianli Lu, Chao Deng. Selective left hemicolectomy after expandable stent placement to relieve obstruction combined with neoadjuvant chemotherapy in the treatment of obstructive left colon cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(04): 430-433.

目的

研究梗阻性左半结肠癌患者可扩张支架置入解除梗阻联合新辅助化疗(NC)后择期行左半结肠根治术的临床疗效。

方法

选取2018年1月至2019年3月两家医院治疗的梗阻性左半结肠癌患者70例，根据治疗方法不同分为两组，各35例。联合组患者在数字减影造影(DSA)引导下可扩张支架置入解除梗阻同期联合NC治疗后择期行左半结肠根治术，对照组患者不做NC治疗，其余治疗相同。采用软件SPSS23.0进行统计学分析。围术期指标等计量资料采用(±s)表示，行独立t检验；并发症等计数资料采用χ2检验，P<0.05表示差异有统计学意义。

结果

两组患者支架置入并发症总发生率比较差异无统计学意义(14.3% vs. 20.0%, P＝0.526)，联合组患者新辅助化疗毒副反应轻，符合手术指征。联合组患者手术时间、术中出血量、术中造口数量、术后引流量、首次排便/进食时间、术后住院时间及术后并发症均显著优于对照组，组间差异有统计学意义(P<0.05)。

结论

DSA引导下可扩张支架置入术联合NC后择期行左半结肠根治术治疗梗阻性左半结肠癌，具有缩短手术时间、降低造口率和并发症发生率，有利于患者术后康复。

关键词: 结肠肿瘤, 支架, 新辅助化疗, 血管造影术, 数字减影
Objective

To study the clinical effect of selective radical resection of left colon in patients with obstructive left colon cancer after the removal of obstruction by dilatable stent implantation combined with neoadjuvant chemotherapy (NC).

Methods

A total of 70 patients with obstructive left colon cancer treated in two hospitals from January 2018 to March 2019 were selected. According to different treatment methods, the patients were divided into two groups with 50 cases each. Under the guidance of digital subtraction angiography (DSA), patients in the combined group were treated with dilated stent to relieve obstruction. After the concurrent NC treatment, the left semicolon was selected for radical resection. Patients in the control group did not receive NC treatment, and other treatments were the same.SPSS23.0 software was used for statistical analysis. Measurement data such as perioperative indicators were represented by (±s), and independent t test was performed.The data of complications were tested by χ2 test, and P<0.05 indicated a statistically significant difference.

Results

There was no statistically significant difference in the total incidence of stent implantation complications between the two groups (14.3% vs. 20.0%, P=0.526), and the toxic and side effects of neoadjuvant chemotherapy were mild in the combined group, consistent with the indications of surgery. The operative time, intraoperative blood loss, intraoperative stoma number, postoperative drainage volume, time of first defecation/feeding, postoperative hospital stay and postoperative complications of the combined group were significantly better than those of the control group, and the differences between the two groups were statistically significant (P<0.05).

Conclusion

Under the guidance of DSA, expansive stent implantation combined with neoadjuvant chemotherapy can be performed at an optional time for the treatment of obstructed left colon cancer, which can shorten the operation time, reduce the rate of stoma and complications, and is conducive to the postoperative rehabilitation of patients.

Key words: Colonic neoplasms, Stents, Neoadjuvant chemotherapy, Angiography, digital subtraction
表1 70例梗阻性左半结肠癌患者不同治疗方法两组一般资料比较[(±s)，例]
组别 例 肿瘤直径 BMI (kg/m2) 年龄(岁) 性别 肿瘤位置 TNM分期 肠梗阻类型 ECOG评分 KPS评分
男/女 A/B/C/D T3N0/ T3N1/T3N2 E/F/G
联合组 35 5.9±1.3 22.3±3.1 50.3±7.6 22/13 10/3/18/4 24/10/1 25/7/3 0.5±0.2 86.2±3.1
对照组 35 6.0±1.4 22.8±3.5 51.5±7.1 18/17 13/2/15/5 23/11/1 23/8/4 0.4±0.5 85.7±2.9
t/χ2值   0.390 0.478 1.152 0.933 7.611 0.069 0.293 1.099 0.697
P值   0.379 0.582 0.126 0.333 0.807 0.966 0.864 0.137 0.244
表2 70例梗阻性左半结肠癌患者不同治疗方法两组术前并发症情况比较(例)
组别 例 间断便血 腹痛 大量便血 肠穿孔 支架移位 严重肠管水肿 总发生率(%)
联合组 35 1 2 1 0 0 1 5(14.3)
对照组 35 1 2 1 1 1 1 7(20.0)
χ2值               0.402
P值               0.526
表3 70例梗阻性左半结肠癌患者不同治疗方法两组围术指标比较(±s)
组别 例 手术时间(min) 术中出血量(ml) 术中造口(例) 术后引流量(ml)
联合组 35 121.5±33.8 100.2±91.2 1 276.1±35.8
对照组 35 162.4±36.9 199.0±109.4 9 290.6±33.2
t/χ2值   3.471 5.327 7.611 1.757
P值   <0.001 <0.001 <0.01 <0.05
组别 例 首次排便时间(d) 进食时间(d) 术后住院时间(d)
联合组 35 3.1±2.1 1.2±0.8 13.4±3.4
对照组 35 5.7±3.8 1.7±1.1 21.5±4.1
t/χ2值   0.038 2.175 0.093
P值   <0.01 <0.05 <0.05
表4 70例梗阻性左半结肠癌患根治术后两组术后并发症水平比较(例)
组别 例 肺部感染 腹腔感染 伤口感染 吻合口漏 肠内出血 肠壁水肿 总发生率(%)
联合组 35 1 0 1 0 0 0 2(5.7)
对照组 35 2 2 2 1 1 2 10(28.7)
χ2值               6.437
P值               <0.05
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