自膨式金属支架桥接手术与急诊手术治疗左侧梗阻性结肠癌的结局比较：一项回顾性队列研究。
Outcomes of self-expandable metal stent as bridge to surgery versus emergency surgery for left-sided obstructing colon cancer: A retrospective cohort study.
机构信息
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.
出版信息
Am J Surg. 2021 Jan;221(1):168-173. doi: 10.1016/j.amjsurg.2020.06.012. Epub 2020 Jun 14.
BACKGROUND
Long-term outcomes of self-expandable metal stents (SEMSs) as bridges to surgery versus emergency surgery in the treatment of left-sided obstructing colon cancer remain unclear.
METHODS
Using a nationwide inpatient database in Japan, we performed one-to-one propensity score matching to compare overall survival, the stoma requirement, postoperative complications, and the length of stay between the SEMS and emergency surgery groups.
RESULTS
Compared with the emergency surgery group, the SEMS group showed worse survival (hazard ratio, 1.80; 95% confidence interval, 1.07-3.01), a higher incidence of postoperative ileus (8% vs. 4%, P = 0.010), a longer postoperative length of stay (14 vs. 12 days, P < 0.001), and a lower stoma requirement (10% vs. 29%, P < 0.001).
CONCLUSIONS
SEMSs as bridges to surgery are associated with significantly poorer overall survival, a higher incidence of postoperative ileus, a longer length of stay, and a lower stoma requirement than is emergency surgery.
背景
在左侧梗阻性结肠癌的治疗中，自膨式金属支架（SEMS）作为手术桥接与急诊手术的长期预后尚不清楚。
方法
我们使用日本全国住院患者数据库，通过 1:1 倾向评分匹配比较 SEMS 组和急诊手术组的总生存率、造口需求、术后并发症和住院时间。
结果
与急诊手术组相比，SEMS 组的生存情况更差（风险比，1.80；95%置信区间，1.07-3.01），术后肠梗阻的发生率更高（8% vs. 4%，P = 0.010），术后住院时间更长（14 天 vs. 12 天，P < 0.001），造口需求更低（10% vs. 29%，P < 0.001）。
结论
SEMS 作为手术桥接与急诊手术相比，总体生存率显著降低，术后肠梗阻发生率更高，住院时间更长，造口需求更低。
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