The Affiliated Suzhou Hospital of Nanjing Medical University, 16 Baita West Road, Suzhou, 215000, People's Republic of China.
Gusu School, Nanjing Medical University, 458 Shizi Road, Suzhou, 215000, People's Republic of China.
Sci Rep. 2023 Jan 28;13(1):1600. doi: 10.1038/s41598-023-28685-y.
The efficacy and safety of self-expanding metallic stent (SEMS) placement as a bridge to elective surgery versus emergency surgery to treat malignant colonic obstruction is debated. This study aimed to evaluate the outcomes of patients with malignant colonic obstruction treated using different procedure. Subjects admitted to the authors' department with colonic obstruction (n = 87) were studied. They underwent colonic stenting as a bridge to elective surgery (SEMS group: n = 14) or emergency surgery (ES group: n = 22).Their demographic characteristics, stoma rate, laparoscopy rate and postoperative complications were analyzed, and the potential risk factors of postoperative complications and the optimal time interval from SEMS implantation to elective surgery were explored. The stoma rate was 15.4% in the SEMS group versus 60.0% in the ES group (P = 0.015), and the postoperative complication rate was 7.7% in the SEMS group versus 40.0% in the ES group (P = 0.042). The proportion of patients undergoing laparoscopy in SEMS group was significantly higher than that in ES group (69.2% vs. 15.0%; P = 0.003).The effect of ASA grade on postoperative complications was statistically significant (OR = 24.565; P = 0.008). The Receiving operating characteristic (ROC) curve could not determine the optimal time interval between SEMS implantation and elective surgery (AUC = 0.466). SEMS implantation has the advantages of lower temporary stoma rate, less postoperative complications and higher laparoscopy rate compared with ES in the treatment of left malignant intestinal obstruction. ASA grade is a risk factor for postoperative complications. However, larger sample size prospective randomized controlled trials (RCT) are still needed to confirm long-term oncological outcomes.
自膨式金属支架（SEMS）置入作为择期手术与急诊手术治疗恶性结肠梗阻的桥梁的疗效和安全性存在争议。本研究旨在评估不同方法治疗恶性结肠梗阻患者的结局。纳入作者科室的结肠梗阻患者（n=87）进行研究。他们接受结肠支架置入作为择期手术（SEMS 组：n=14）或急诊手术（ES 组：n=22）的桥梁。分析其人口统计学特征、造口率、腹腔镜率和术后并发症，并探讨术后并发症的潜在危险因素和 SEMS 植入至择期手术的最佳时间间隔。SEMS 组的造口率为 15.4%，ES 组为 60.0%（P=0.015），SEMS 组的术后并发症发生率为 7.7%，ES 组为 40.0%（P=0.042）。SEMS 组行腹腔镜手术的患者比例明显高于 ES 组（69.2%比 15.0%；P=0.003）。ASA 分级对术后并发症的影响有统计学意义（OR=24.565；P=0.008）。SEMS 植入与择期手术之间的最佳时间间隔无法通过接受者操作特征（ROC）曲线确定（AUC=0.466）。SEMS 植入与 ES 相比，在治疗左半侧恶性肠梗阻时具有较低的临时造口率、较少的术后并发症和更高的腹腔镜率。ASA 分级是术后并发症的危险因素。然而，仍需要更大样本量的前瞻性随机对照试验（RCT）来确认长期肿瘤学结局。
