Yang Leilei, Ma Weiwei, Wang Meizhen, Zhang Ruili, Bi Tienan, Zhou Shenkang
Department of Gastrointestinal Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou, Zhejiang 317000, P.R. China.
Department of Endoscopic Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou, Zhejiang 317000, P.R. China.
Oncol Lett. 2019 Aug;18(2):1931-1937. doi: 10.3892/ol.2019.10525. Epub 2019 Jun 24.
There is still controversy on the surgical treatment of obstructive colorectal cancer worldwide. No accurate research has been reported to propose which method is the most suitable for patients with obstructive colorectal cancer. Therefore, comparison of efficacy of intestinal stent and trans-anal ileus catheter combined with laparoscopic surgery and neoadjuvant chemotherapy respectively in patients with obstructive colorectal cancer was carried out to provide reference and guidance for the selection of surgical schemes for patients with obstructive colorectal cancer. In total 89 patients with obstructive colorectal cancer treated in the Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, from February 2016 to March 2017 were selected for retrospective analysis. Forty-nine cases treated with intestinal metal stent implantation combined with laparoscopic surgery and neoadjuvant chemotherapy were the stent group. The other 40 cases treated with trans-anal ileus catheter combined with laparoscopic surgery and neoadjuvant chemotherapy were the catheter group. The intestinal preparation time, surgical duration, intraoperative blood loss, open surgery rate, postoperative exhaust time and adverse reaction rate were compared between the two groups. All the patients were followed up with reexamination at 1 year in hospital to record the local recurrence rate and tumor implantation rate of incision. The intestinal preparation time in the stent group was shorter than that in the catheter group (P<0.001). The surgical duration in the stent group was longer than that in the catheter group (P<0.001). The intraoperative blood loss in the stent group was higher than that in the catheter group (P<0.001). However, there was no significant difference in open surgery rate, postoperative exhaust time, adverse reaction rate, local recurrence rate or incision tumor implantation rate between the two groups (all P>0.05). Therefore, intestinal metal stent implantation can effectively relieve intestinal obstruction, while trans-anal ileus catheter has higher safety in laparoscopic surgery. Their combination with neoadjuvant chemotherapy and laparoscopic surgery for obstructive colorectal cancer has high value and clinical effect. The best treatment plan should be selected according to the patient's condition.
目前，全球范围内对于梗阻性结直肠癌的外科治疗仍存在争议。尚无准确研究报告提出哪种方法最适合梗阻性结直肠癌患者。因此，本研究分别比较了肠道支架、经肛门肠梗阻导管联合腹腔镜手术及新辅助化疗在梗阻性结直肠癌患者中的疗效，为梗阻性结直肠癌患者手术方案的选择提供参考和指导。选取2016年2月至2017年3月在温州医科大学附属台州医院接受治疗的89例梗阻性结直肠癌患者进行回顾性分析。49例行肠道金属支架植入联合腹腔镜手术及新辅助化疗的患者为支架组。另外40例行经肛门肠梗阻导管联合腹腔镜手术及新辅助化疗的患者为导管组。比较两组患者的肠道准备时间、手术时间、术中出血量、开腹手术率、术后排气时间及不良反应发生率。所有患者均在术后1年于本院进行随访复查，记录局部复发率及切口种植转移率。支架组肠道准备时间短于导管组（P<0.001）。支架组手术时间长于导管组（P<0.001）。支架组术中出血量多于导管组（P<0.001）。然而，两组患者的开腹手术率、术后排气时间、不良反应发生率、局部复发率及切口种植转移率比较，差异均无统计学意义（均P>0.05）。因此，肠道金属支架植入可有效缓解肠梗阻，而经肛门肠梗阻导管在腹腔镜手术中安全性更高。二者联合新辅助化疗及腹腔镜手术治疗梗阻性结直肠癌具有较高的应用价值及临床疗效。应根据患者病情选择最佳治疗方案。
