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

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

Abstract

Abstract:

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

Liang Sun, Wei Cui, Yuqi He, Qiang Yuan, Junfeng Du, Yuhui Nie, Xing Dong, Jinlu Geng, Gang Chen, Shiyong Li. Clinical application of self-expandable metal stents in the preoperative management of acute obstructive colorectal cancer, report of 25 cases[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(05): 468-471.

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References 23

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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

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

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

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

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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