中国实用外科杂志

中国实用外科杂志

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自膨式金属支架用于结肠癌并急性完全肠梗阻治疗回顾性对照研究

赵晓牧，王    今，金    岚，吴国聪，杨盈赤，姚宏伟，张忠涛   

  1. 国家消化系统疾病临床医学研究中心 首都医科大学附属北京友谊医院普通外科，北京 100050
  • 出版日期:2018-10-01 发布日期:2018-10-10

  • Online:2018-10-01 Published:2018-10-10

摘要：

目的    探讨自膨式金属支架（SEMS）置入后限期手术治疗急性完全梗阻性结肠癌近期及远期效果。方法    回顾性分析2007年1月至2016年12月首都医科大学附属北京友谊医院普通外科收治的128例结肠癌伴完全梗阻症状病人的临床资料。手术方式分为急诊手术（急诊组，76例）和SEMS置入后限期手术（支架组，52例）。对两组病人的手术安全性、肿瘤根治性、永久肠造口比例及存活率进行比较分析。结果    支架组与急诊组在手术入路方式、手术时间方面差异无统计学意义。与急诊组相比，支架组围手术期总并发症发生率（21.2% vs. 39.5%，P=0.029）较低，但Ⅲ、Ⅳ级并发症发生率（11.5% vs. 14.5%，P=0.631）和病死率（0 vs. 2.6%）差异无统计学意义（P>0.05）；淋巴结清扫总数较多［（18.2±6.7）枚 vs. （16.0±9.9）枚，P=0.022］，淋巴结清扫数目≥12枚比例较高（86.5% vs. 55.3%，P=0.001），永久造口率较低（23.1% vs. 59.2%，P<0.05）。3年总存活率（71.6% vs. 67.8%，P=0.215）和无病存活率（77.0% vs. 64.7%，P=0.703）两组间差异无统计学意义。 结论    SEMS置入后限期手术可以明显提高结肠癌并急性完全梗阻病人的围手术期安全性，减少永久造口，提高肿瘤根治率，同时未影响远期疗效。

关键词: 结直肠癌, 急性肠梗阻, 自膨式金属支架

Abstract:

Clinical application of self-expending metallic stent in the management of acute colorectal malignant obstruction        ZHAO Xiao-mu，WANG Jin，JIN Lan，et al. Department of General Surgery，Beijing Friendship Hospital，Capital Medical University；Key Laboratory of Cancer Invision and Metastasis Research & National Clinical Research Center for Digestive Disease，Beijing 100050，China
Corresponding author: ZHANG Zhong-tao，E-mail：zhangzht@ccmu.edu.cn
Abstract    Objective    To explore the short and long term efficacy of bridge to surgery (BTS) in the treatment of acute malignant colorectal cancer obstruction ( AMCO ). Methods    The clinical data of 128 patients with AMCO treated by BTS or acute resection (ES) between January 2007 and December 2016 in Department of General Surgery，Beijing Friendship Hospital，Capital Medical University were analyzed retrospectively. Fifty-two patients and senventy-six patients performed BTS and ES，respectively. The surgical safety，radical tumor，permanent intestinal stoma ratio and survival rate of two groups were compared and analyzed. Results    Compared with the ES group，BTS gruop had no difference in the operative approach and time. The incidence of total perioperative complications (21.2% vs. 39.5%，P=0.029) was lower in the BTS one，but there were no significant difference in the incidence of class Ⅲ/Ⅳ complications (11.5 % vs. 14.5 %，P=0.631) and mortality ( 0 vs 2.6 % ) between two groups. The total number of lymph node harvest was more (18.2±6.7 vs. 16.0±9.9，P=0.022)，the number of lymph node harvest ≥ 12 was higher (86.5 % vs. 55.3 %，P =0.001) and the permanent stoma rate was lower (23.1 % vs. 59.2 %，P=0.000). There was no significant difference between the two groups in the three-year overall survival rate (71.6% vs. 67.8%，P=0.215）and disease-free survival rate （77.0% vs. 64.7%，P=0.703）. Conclusion    Bridge to surgery can significantly improve the perioperative safety of patients with AMCO，reduce the proportion of permanent stoma，improve the proportion of tumor radical operation. Meanwhile，the long-term survival is not affected.

Key words: colorectal cancer, acute intestinal obstruction, self-expanding metallic stents