目的

探究不同术式治疗梗阻性左半结直肠癌的疗效观察。

方法

回顾性分析2019年1月至2021年1月103例梗阻性左半结直肠癌患者临床资料，根据实施手术方案分为择期组（行肠道支架联合择期手术，n=54例）与常规组（行常规急诊Ⅰ期肿瘤切除吻合术，n=49例）。数据利用SPSS22.0统计学软件分析。术后并发症发生率、Ⅰ期吻合率、造口率、开腹率等计数资料以［例（%）］表示，行χ²检验；围手术期指标、术后3个月肠道屏障功能［二胺氧化酶（DAO）、D-乳酸］等计量资料以（x±s）表示，行独立样本t检验；3年内生存情况采用Kaplan-Meier绘制生存曲线。P＜0.05为差异有统计学意义。

结果

择期组手术时间、术中出血量、淋巴结清扫数量、永久造口率及开腹率显著低于常规组（P＜0.05），Ⅰ期吻合率显著高于常规组（P＜0.05）；择期组并发症发生率（13.0%）显著低于常规组（30.6%）（P＜0.05）；术后3个月，两组患者DAO与D-乳酸均显著上升（P＜0.05），择期组显著低于常规组（P＜0.05）；所有患者均成功随访3年，中位随访时间27个月，择期组患者无进展生存期（PFS）为（31.6±8.3）个月，总生存期（OS）为（33.9±5.3）个月；常规组PFS为（33.0±6.6）个月，OS为（34.8±3.4）个月，两组OS与PFS均无统计学意义（P＞0.05）。

结论

肠道支架联合择期手术在缩短手术时间、减少术中出血量、降低永久造口率及开腹率、提高Ⅰ期吻合率等方面均有显著优势，且患者预后良好，并发症少，值得应用。

Objective

To explore the curative effect of different operation methods in the treatment of obstructive left colorectal cancer.

Methods

Clinical data of 103 patients with obstructive left half colorectal cancer from January 2019 to January 2021 were retrospectively analyzed.According to the operative plan， they were divided into the elective group （receiving intestinal stent combined elective surgery， n=54 cases） and the conventional group （receiving routine emergency stage I tumor resection and anastomosis， n=49 cases）.Data were analyzed using SPSS22.0 statistical software.The incidence of postoperative complications， stage I anastomosis rate， stomy rate and laparotomy rate were expressed as［ cases （%）］， χ² test was performed.Perioperative indexes and intestinal barrier function （DAO， D-lactic acid） 3 months after surgery were expressed in the form of （x± s ）， and independent sample t test was performed.Kaplan-Meier was used to draw the survival curve for the 3-year survival.P＜0.05 was statistically significant.

Results

The operative time， intraoperative blood loss， number of lymph node dissection， permanent stomy rate and laparotomy rate of the elective group were significantly lower than those of the conventional group （P＜0.05）， and the anastomosis rate of stageⅠwas significantly higher than that of the conventional group （P＜0.05）.The complication rate of the selective group（13.0%） was significantly lower than that of the conventional group （30.6%） （P＜0.05）.Three months after surgery， DAO and D-lactic acid were significantly increased in 2 groups （P＜0.05）， and the selective group was significantly lower than the conventional group （P＜0.05）.All patients were successfully followed up for 3 years with a median follow-up time of 27 months.The progression-free survival （PFS） and overall survival （OS） in the selective group were （31.6±8.3） months and （33.9±5.3） months respectively.PFS and OS in the conventional group were （33.0±6.6） months and （34.8±3.4） months， and there was no statistical significance in OS and PFS in the two groups （P＞0.05）.

Conclusion

Intestinal stents combined with elective surgery have significant advantages in shortening operation time， reducing intraoperative blood loss， reducing the rate of permanent ostomy and laparotomy， and improving the rate of stage I anastomosis.Besides， the prognosis of patients is good with few complications， and it is worthy of application.