金属支架置入术治疗左半结肠癌合并梗阻疗效分析
|
摘要
目的探讨经内镜自膨式金属支架置入术在左半结肠癌合并梗阻术前的应用价值。方法选择2009年1月～2015年1月我院收治的左半结肠癌合并肠梗阻患者84例,根据随机数字表法分为两组,每组42例。观察组采取术前支架置入术,对照组采用传统手术治疗,对比两组的手术时间、术中出血量、术后排气时间、术后并发症发生率、平均住院时间、腹腔引流时间以及生存期死亡率。结果观察组腹腔镜手术率为90.47%(38/42),Ⅰ期切除吻合率为97.61%(41/42),均高于对照组(P<0.05);两组手术时间比较无统计学差异(P>0.05),观察组术中出血量(68.41±20.47)ml少于对照组的(125.25±20.13)ml (P<0.05),术后排气时间(2.81±0.42)d短于对照组(4.50±0.33)d(P<0.05);观察组并发症发生率(14.29%)低于对照组(40.48%)(P<0.05);观察组腹腔引流时间短于对照组(P<0.05)。对照组3年、5年死亡率分别为14.29%、30.95%,平均生存期(48.20±13.13)个月,高于观察组的4.76%、11.90%、(67.41±15.93)个月,(P均<0.05)。结论左半结肠癌合并梗阻,术前采用经内镜自膨式金属支架置入术,可以有效提高I期吻合率,减少术中出血量,并显著降低并发症发生率,促进术后恢复。
Objective To evaluate the value of endoscopic self-expanding metal stent placement in the treatment of left colon cancer with obstruction.Methods From January 2009 to January 2015, 84 patients with left colon cancer and intestinal obstruction admitted to our hospital were randomly divided into two groups according to the digital table method, 42 cases in each group. The observation group underwent preoperative stenting, and the control group was treated with conventional surgery. The operation time, intraoperative blood loss, postoperative exhaust time, postoperative complication rate, average hospital stay, abdominal drainage time, and Survival mortality. Results The laparoscopic surgery rate was 90.47%, and the stage I resection rate was 97.61%, which was higher than 26.19% and 26.19% of the control group(P<0.05). There was no significant difference in operation time between the two groups(P>0.05), the intraoperative blood loss(68.41±20.47) ml in the observation group was lower than that in the control group(125.25±20.13) ml(P<0.05), and the postoperative exhaust time(2.81±0.42) d was shorter than the control group(4.50±0.33) d(P<0.05);the incidence of complications in the observation group(14.29%) was lower than that in the control group(40.48%)( P<0.05). The drainage time in the observation group was shorter than that in the control group(P<0.05). The 3-year and 5-year mortality rates of the control group were 14.29% and30.95%, respectively, and the average survival time was(48.20±13.13) months, which was higher than the observation group's 4.76%, 11.90%, and(67.41±15.93) months(P<0.05). Conclusion Left colon cancer with obstruction and endoscopic self-expanding metal stent placement can effectively improve the rate of I-stage anastomosis, reduce the amount of intraoperative blood loss, and significantly reduce the incidence of complications and promote postoperative recovery.
Objective To evaluate the value of endoscopic self-expanding metal stent placement in the treatment of left colon cancer with obstruction.Methods From January 2009 to January 2015, 84 patients with left colon cancer and intestinal obstruction admitted to our hospital were randomly divided into two groups according to the digital table method, 42 cases in each group. The observation group underwent preoperative stenting, and the control group was treated with conventional surgery. The operation time, intraoperative blood loss, postoperative exhaust time, postoperative complication rate, average hospital stay, abdominal drainage time, and Survival mortality. Results The laparoscopic surgery rate was 90.47%, and the stage I resection rate was 97.61%, which was higher than 26.19% and 26.19% of the control group(P<0.05). There was no significant difference in operation time between the two groups(P>0.05), the intraoperative blood loss(68.41±20.47) ml in the observation group was lower than that in the control group(125.25±20.13) ml(P<0.05), and the postoperative exhaust time(2.81±0.42) d was shorter than the control group(4.50±0.33) d(P<0.05);the incidence of complications in the observation group(14.29%) was lower than that in the control group(40.48%)( P<0.05). The drainage time in the observation group was shorter than that in the control group(P<0.05). The 3-year and 5-year mortality rates of the control group were 14.29% and30.95%, respectively, and the average survival time was(48.20±13.13) months, which was higher than the observation group's 4.76%, 11.90%, and(67.41±15.93) months(P<0.05). Conclusion Left colon cancer with obstruction and endoscopic self-expanding metal stent placement can effectively improve the rate of I-stage anastomosis, reduce the amount of intraoperative blood loss, and significantly reduce the incidence of complications and promote postoperative recovery.
引文
[1]李道娟,李倩,贺宇彤.结直肠癌流行病学趋势[J].肿瘤防治研究,2015,42(3):305-310.
[2]罗福文.高度重视老年结肠癌合并肠梗阻的诊断和外科治疗[J].中华临床医师杂志(电子版),2014,8(22):3935-3938.
[3]吴永丰,刘兴洲,柳东.左半结肠癌并急性肠梗阻患者的术式选择及肠减压分析[J].实用临床医药杂志,2017,21(13):126-127.
[4]郁雷,王锡山.2014日本大肠癌规约更新内容解析[J].中华结直肠疾病电子杂志,2015(3):17-20.
[5]秦开烈.支架置入术治疗结直肠癌并发肠梗阻临床分析[J].医学综述,2014,20(20):3801-3802.
[6]许允发,王琦,王强.CT对大肠癌并急性肠梗阻的诊断价值分析[J].结直肠肛门外科,2017,23(6):774-776.
[7]Ming G,Guo Y,Feng J,et al.Factors associated with mortality risk for malignant colonic obstruction in elderly patients[J].BMC gastroenterology,2014(14):76.
[8]Jeremy K,Anna S,Douglas G,et al.Enteral stents for the management of malignant colorectal obstruction[J].World J Gastroenterol,2014,20(37):13239-13245.
[9]Hong SP,Kim Tl.Colorectal stenting:An advanced approach to malignant colorectal obstruction[J].World J Gastroenterol,2014,20(43):16020-16028.
[10]Lee H,Park S,Min B,et al.The role of primary colectomy after successful endoscopic stenting in patients with obstructive metastatic.colorectal cancer[J].Dis Colon Rectum,2014(57):694-699.
[11]DiMitri R,Mocciaro F,Traina M,et al.Self-expandable metal stents for malignant colonic obstruction:Data from a retrospective regional SIED-AIGO study[J].Dig liver Dis,2014,46(9):861.
[2]罗福文.高度重视老年结肠癌合并肠梗阻的诊断和外科治疗[J].中华临床医师杂志(电子版),2014,8(22):3935-3938.
[3]吴永丰,刘兴洲,柳东.左半结肠癌并急性肠梗阻患者的术式选择及肠减压分析[J].实用临床医药杂志,2017,21(13):126-127.
[4]郁雷,王锡山.2014日本大肠癌规约更新内容解析[J].中华结直肠疾病电子杂志,2015(3):17-20.
[5]秦开烈.支架置入术治疗结直肠癌并发肠梗阻临床分析[J].医学综述,2014,20(20):3801-3802.
[6]许允发,王琦,王强.CT对大肠癌并急性肠梗阻的诊断价值分析[J].结直肠肛门外科,2017,23(6):774-776.
[7]Ming G,Guo Y,Feng J,et al.Factors associated with mortality risk for malignant colonic obstruction in elderly patients[J].BMC gastroenterology,2014(14):76.
[8]Jeremy K,Anna S,Douglas G,et al.Enteral stents for the management of malignant colorectal obstruction[J].World J Gastroenterol,2014,20(37):13239-13245.
[9]Hong SP,Kim Tl.Colorectal stenting:An advanced approach to malignant colorectal obstruction[J].World J Gastroenterol,2014,20(43):16020-16028.
[10]Lee H,Park S,Min B,et al.The role of primary colectomy after successful endoscopic stenting in patients with obstructive metastatic.colorectal cancer[J].Dis Colon Rectum,2014(57):694-699.
[11]DiMitri R,Mocciaro F,Traina M,et al.Self-expandable metal stents for malignant colonic obstruction:Data from a retrospective regional SIED-AIGO study[J].Dig liver Dis,2014,46(9):861.