Han Lijiang, Song Xinjiang, Yu Bin, Zhou Mingliang, Zhang Liping, Sun Guogang
Lijiang Han, Department of Anal and Intestinal Surgery, Shaoxing Second Hospital, No. 141 Yan'an Road, Shaoxing 312000, Zhejiang Province, P. R. China.
Xinjiang Song, Department of Anal and Intestinal Surgery, Shaoxing Second Hospital, No. 141 Yan'an Road, Shaoxing 312000, Zhejiang Province, P. R. China.
Pak J Med Sci. 2020 Mar-Apr;36(3):376-381. doi: 10.12669/pjms.36.3.1707.
To evaluate the safety of preoperative stent insertion and compare the short- and long-term outcomes between preoperative stent insertion and emergency surgery in the treatment of obstructive left-sided colorectal cancer.
The clinical data of 302 patients who underwent surgery for obstructive left-sided colorectal cancer from January 2009 to May 2014 were retrospectively analyzed. They were divided into two groups according to whether to receive stenting for the success rate and complications of stent insertion in colonic lumen by colonoscope, and the number of cases of primary resection and anastomosis, and short-term complications such as incision infection, anastomotic leakage, spleen tear and abdominal abscess as well as mortality and survival rate during hospitalization were compared.
The success rate of endoscopic nitinol alloy memorial stent insertion in colonic lumen was 97.62%, and the overall incidence of complications was 14.5%, of which the incidence of serious complications (perforation, stent migration) was 4.76%. The primary anastomosis rate was significantly higher in the stent insertion group (85.71%) than that in the emergency surgery group (36.24%). The overall complication rate in the stent insertion group (14 cases) was significantly lower than that in the emergency surgery group (102 cases). There was no significant difference between survival curves (P>0.05).
Preoperative stent insertion in colonic lumen by colonoscope for decompression is an ideal auxiliary method in the treatment of obstructive left-sided colorectal cancer, and may increase primary anastomosis rate, avoid neostomy, reduce short-term complications, and improve the long-term survival compared to emergency surgery.
评估术前置入支架的安全性，并比较术前置入支架与急诊手术治疗左侧结直肠癌梗阻的短期和长期疗效。
回顾性分析2009年1月至2014年5月期间接受手术治疗左侧结直肠癌梗阻的302例患者的临床资料。根据是否接受结肠镜下结肠腔内支架置入术，将患者分为两组，比较两组的支架置入成功率、并发症、一期切除吻合病例数、切口感染、吻合口漏、脾破裂、腹腔脓肿等短期并发症以及住院期间的死亡率和生存率。
结肠镜下镍钛合金记忆支架置入结肠腔的成功率为97.62%，并发症总发生率为14.5%，其中严重并发症（穿孔、支架移位）发生率为4.76%。支架置入组的一期吻合率（85.71%）显著高于急诊手术组（36.24%）。支架置入组的总体并发症发生率（14例）显著低于急诊手术组（102例）。生存曲线之间无显著差异（P>0.05）。
结肠镜下结肠腔内术前置入支架减压是治疗左侧结直肠癌梗阻的理想辅助方法，与急诊手术相比，可能提高一期吻合率，避免造口，减少短期并发症，并改善长期生存。
