[自膨式金属支架在梗阻性左半结肠癌或直肠癌中的价值]
[Value of self-expanding metallic stent for obstructing left-sided colon cancer or rectal cancer].
作者信息
Ma Hua-chong, Zhao Bo, Zhao Bao-cheng, Yu Xue-qiao, Zhang Jie, Hao Jian-yu, Wei Guang-hui, Wang Zhen-jun
机构信息
Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
出版信息
Zhonghua Wai Ke Za Zhi. 2012 Jul;50(7):618-21.
OBJECTIVE
To investigate the therapeutic value of self-expanding metallic stent (SEMS) for resectable obstructing left-sided colon cancer or rectal cancer.
METHODS
Clinical data of 73 patients who had acute obstruction due to left-sided colon cancer or rectal cancer during May 2007 to January 2012 were retrospectively analyzed. The patients were divided into 2 groups: SEMS group (34 cases) underwent surgical resection after insertion of SEMS; emergency surgery group (39 cases) underwent emergency operation. The 2 group patients were compared for the incidence of primary anastomosis, stoma rate, laparoscopic surgery rate, mortality, postoperative morbidity, ICU admission rate, length of ICU stay, hospital stay, and hospitalization costs.
RESULTS
The incidence of primary anastomosis in SEMS group was significantly higher than that in emergency surgery group (97.1% vs. 56.4%, χ(2) = 16.256, P < 0.001), and the protective stoma rate and permanent stoma rate in SEMS group were both lower than those in emergency surgery group (33.3% vs. 86.3%, 2.9% vs. 43.6%, χ(2) value were 14.972 and 16.156, both P < 0.001). Patients in SEMS group underwent significantly more laparoscopic surgery than in emergency surgery group (47.1% vs. 0, χ(2) = 23.505, P < 0.001). There were no significant difference in postoperative mortality (2.9% vs. 10.3%, P = 0.364). The postoperative morbidity in SEMS group was significantly lower than that in emergency surgery group (35.3% vs. 66.7%, P = 0.007). Incisional infection was the most common complication in both groups, and the incidence of which seemed to be more higher in emergency surgery group (17.6% vs. 38.5%, χ(2) = 3.840, P = 0.050). There was a lower ICU admission rate in SEMS group (24.2% vs. 53.9%, χ(2) = 6.972, P = 0.008), and the mean length of ICU stay and hospital stay were both shorter in SEMS group ((69.5 ± 7.4) hours vs. (114.3 ± 10.9) hours, t = -20.23, P < 0.001; (19.6 ± 4.8) days vs. (23.4 ± 6.2) days, t = -2.90, P = 0.005). The cost of hospitalization was less in SEMS group (45 383 ± 15 648 vs. 61 485 ± 20 380, t = -3.74, P < 0.001).
CONCLUSIONS
SEMS can effectively relieve the large intestinal obstruction caused by left-sided colon cancer or rectal cancer, and change the traditional emergency surgery into a selective surgery with better outcomes. SEMS appears to be a valuable technique for resectable obstructing left-sided colorectal cancer.
目的
探讨自膨式金属支架（SEMS）对可切除的左侧结肠癌或直肠癌所致梗阻的治疗价值。
方法
回顾性分析2007年5月至2012年1月期间73例因左侧结肠癌或直肠癌导致急性梗阻患者的临床资料。将患者分为2组：SEMS组（34例）在置入SEMS后接受手术切除；急诊手术组（39例）接受急诊手术。比较两组患者的一期吻合率、造口率、腹腔镜手术率、死亡率、术后发病率、重症监护病房（ICU）入住率、ICU住院时间、住院时间及住院费用。
结果
SEMS组的一期吻合率显著高于急诊手术组（97.1%对56.4%，χ² = 16.256，P < 0.001），SEMS组的保护性造口率和永久性造口率均低于急诊手术组（33.3%对86.3%，2.9%对43.6%，χ²值分别为14.972和16.156，均P < 0.001）。SEMS组接受腹腔镜手术的患者明显多于急诊手术组（47.1%对0，χ² = 23.505，P < 0.001）。术后死亡率无显著差异（2.9%对10.3%，P = 0.364）。SEMS组的术后发病率显著低于急诊手术组（35.3%对66.7%，P = 0.007）。切口感染是两组最常见的并发症，急诊手术组的发生率似乎更高（17.6%对38.5%，χ² = 3.840，P = 0.050）。SEMS组的ICU入住率较低（24.2%对53.9%，χ² = 6.972，P = 0.008），SEMS组的平均ICU住院时间和住院时间均较短（（69.5 ± 7.4）小时对（114.3 ± 10.9）小时，t = -20.23，P < 0.001；（19.6 ± 4.8）天对（23.4 ± 6.2）天，t = -2.90，P = 0.005）。SEMS组的住院费用较少（45 383 ± 15 648对61 485 ± 20 380，t = -3.74，P < 0.001）。
结论
SEMS可有效缓解左侧结肠癌或直肠癌所致的大肠梗阻，并将传统的急诊手术转变为选择性手术，效果更佳。对于可切除的左侧结直肠癌梗阻，SEMS似乎是一项有价值的技术。
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