内镜下支架置入结合择期手术与急诊手术治疗梗阻性结直肠癌临床研究
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摘要
目的探讨内镜下支架置入联合择期手术与急诊手术治疗梗阻性结直肠癌的临床价值。方法回顾性分析2013年7月至2017年7月武汉市黄陂区中医医院外一科收治的66例梗阻性结直肠癌患者的临床资料,根据资料中不同的治疗方法将其分为对照组和观察组,每组33例,观察组予以内镜下支架置入联合择期手术治疗,对照组予以急诊手术治疗,比较两组患者一期切除吻合率、住院时间、手术时间、术后通气时间、并发症和住院期间死亡情况。结果观察组患者的一期切除吻合率为96.97%,明显高于对照组的57.58%,差异有统计学意义(P<0.05);观察组患者的手术时间和术后通气时间分别为(156.02±49.68) min、(3.58±1.38) d,均较对照组的(180.42±48.06) min、(4.50±2.07) d明显缩短,差异均有统计学意义(P<0.05);观察组患者的总并发症发生率为6.06%,明显低于对照组的30.30%,差异有统计学意义(P<0.05)。结论内镜下支架置入联合择期手术治疗梗阻性结直肠癌患者可使一期切除吻合率显著提高,迅速缓解肠梗阻症状,减少并发症。
Objective To investigate the clinical value of endoscopic stent implantation combined with elective surgery and emergency operation in the treatment of patients with obstructive colorectal cancer. Methods The clinical data of 66 cases of patients with obstructive colorectal cancer, who admitted to the First Department of Surgery, the Chinese Medicine Hospital of Huangpi District of Wuhan from July 2013 to July 2017, were retrospectively analyzed.According to the different treatment methods, the cases were divided into the control group and the study group with 33 cases in each group. The study group was treated with stent implantation combined with endoscopic surgery, and the control group received emergency surgical treatment. The one stage resection rate, hospitalization time, operation time,postoperative ventilation time, complications during hospitalization, and death were compared between the two groups Results(1) the rate of one-stage resection and anastomosis in the study group(96.97%) was significantly higher than that in the control group(57.58%), P<0.05;(2) the operation time and postoperative ventilation time in the study group were(156.02±49.68) min,(3.58±1.38) d, respectively, which were significantly shorter than corresponding(180.42±48.06) min and(4.50±2.07) d in the control group(P<0.05);(3) the complication rate of study group(6.06%)was significantly lower than that in the control group(30.30%), P<0.05. Conclusion Endoscopic stent placement combined with elective surgery for obstructive colorectal cancer can significantly improve the one-stage resection and anastomosis rate, relieve symptoms of intestinal obstruction and reduce complications.
Objective To investigate the clinical value of endoscopic stent implantation combined with elective surgery and emergency operation in the treatment of patients with obstructive colorectal cancer. Methods The clinical data of 66 cases of patients with obstructive colorectal cancer, who admitted to the First Department of Surgery, the Chinese Medicine Hospital of Huangpi District of Wuhan from July 2013 to July 2017, were retrospectively analyzed.According to the different treatment methods, the cases were divided into the control group and the study group with 33 cases in each group. The study group was treated with stent implantation combined with endoscopic surgery, and the control group received emergency surgical treatment. The one stage resection rate, hospitalization time, operation time,postoperative ventilation time, complications during hospitalization, and death were compared between the two groups Results(1) the rate of one-stage resection and anastomosis in the study group(96.97%) was significantly higher than that in the control group(57.58%), P<0.05;(2) the operation time and postoperative ventilation time in the study group were(156.02±49.68) min,(3.58±1.38) d, respectively, which were significantly shorter than corresponding(180.42±48.06) min and(4.50±2.07) d in the control group(P<0.05);(3) the complication rate of study group(6.06%)was significantly lower than that in the control group(30.30%), P<0.05. Conclusion Endoscopic stent placement combined with elective surgery for obstructive colorectal cancer can significantly improve the one-stage resection and anastomosis rate, relieve symptoms of intestinal obstruction and reduce complications.
引文
[1]姜冰.腹腔镜联合肠镜治疗结直肠癌合并肠梗阻的临床疗效与安全性分析[J].中国现代普通外科进展, 2016, 19(1):47-49.
[2]谢德金,王小忠,彭云恒,等.经内镜支架置入联合腹腔镜手术治疗左侧大肠癌性梗阻的临床价值[J].腹腔镜外科杂志, 2016, 21(11):832-836.
[3]闫飞虎,曹光材,刘小双,等.结肠镜非透视下自扩张金属支架在处理梗阻性结直肠癌中的临床应用研究[J].中华航海医学与高气压医学杂志, 2016, 23(4):293-297.
[4]韦振轩,陈小勋. X线辅助内镜置入支架联合腹腔镜手术治疗结直肠癌并梗阻的疗效分析[J].中国普通外科杂志, 2016, 25(4):475-480.
[5]石磊,赵伟,周宇,等.肠道支架置入术与急诊手术治疗急性梗阻性结直肠癌疗效的Meta分析[J].中国全科医学, 2016, 19(8):941-945.
[6]程云飞.腹腔镜联合肠镜下支架置入治疗结直肠癌合并肠梗阻37例临床观察[J].中国临床医生杂志, 2016, 44(12):75-77.
[7] PARK SJ, LEE KY, KWON SH, et al. Stenting as a bridge to surgery for obstructive colon cancer:does it have surgical merit or oncologic demerit[J]. Annals of Surgical Oncology, 2016, 23(3):842-848.
[8]陈俊杰,赖亚栋,李东升,等.肠道支架及肠梗阻导管治疗急性左半结直肠癌性梗阻的研究[J].中华消化内镜杂志, 2016, 33(4):252-254.
[9]方日,王小文. CDH1基因甲基化状态与结直肠癌临床病理特征及预后的相关性研究[J].海南医学, 2016, 27(11):1779-1782.
[10]靳红绪,黄立宁,王忠义,等.加速康复外科策略对腹腔镜结直肠癌手术患者术后恢复的影响[J].临床麻醉学杂志, 2016, 32(12):1149-1153.
[11]叶刚,朱贤林,吴述轩,等.盐酸右美托咪定对腹腔镜结直肠癌根治术患者麻醉苏醒质量的影响[J].医药导报, 2017, 36(2):175-178.
[12]杨悦,马铃,代玉婷,等.盐酸右美托咪定对开腹结直肠癌根治术患者围术期肺动态顺应性和外周血中TLR-2和TLR-4表达的影响[J].中国医科大学学报, 2016, 45(12):1077-1081.
[13]汪少华,李玲,郭翠华,等.空气压力治疗仪结合低相对分子质量肝素预防结直肠癌术后深静脉血栓形成的效果[J].血栓与止血学,2017, 23(2):308-309.
[14]张娜,李志霞,肖慧杰,等.经内镜植入自膨式金属支架治疗结直肠癌性梗阻的安全性与有效性分析[J].实用癌症杂志, 2016, 31(7):1101-1104.
[15]冯凯瑜,范明娟,谭荣荣,等.粪便中MGMT,p16INK4A及ECAD基因启动子甲基化检测在结直肠癌诊断中的价值[J].海南医学,2016, 27(21):3461-3463.
[16]赵鹏,白鍊,李启刚,等.梗阻性结直肠癌中E-cadherin、CD44v6的表达及与预后的关系[J].第三军医大学学报, 2016, 38(6):629-633.
[17]刘晖,朱贤章.置入支架后择期手术与急诊手术在梗阻性结直肠癌中的对比研究[J].中国现代普通外科进展, 2017, 20(3):184-187.
[18]刘英俊,王刚成,万相斌,等.带蒂大网膜预防梗阻性结直肠癌术后吻合口瘘的疗效[J].中华普通外科杂志, 2017, 32(1):23-25.
[19]宋冰,张文婧,李东印,等.经肛门肠梗阻导管联合腹腔镜手术治疗左半梗阻性结直肠癌的效果研究[J].中国急救医学, 2016, 36(1):110-111.
[20] FERRONI P, SPILA A, MARTINI F, et al. Prognostic value of vascular endothelial growth factor tumor tissue content of colorectal cancer.[J]. Oncology, 2016, 69(2):145-153.
[21]石洋,张锡朋,许晨,等.经鼻肠梗阻导管治疗老年结直肠癌术后炎性早期肠梗阻[J].中国中西医结合外科杂志, 2016, 22(6):586-588.
[22]张全超,孙学军.自膨式金属支架对结直肠癌合并肠梗阻患者术后疼痛及恢复质量的影响[J].国际消化病杂志, 2016, 36(6):381-383.
[2]谢德金,王小忠,彭云恒,等.经内镜支架置入联合腹腔镜手术治疗左侧大肠癌性梗阻的临床价值[J].腹腔镜外科杂志, 2016, 21(11):832-836.
[3]闫飞虎,曹光材,刘小双,等.结肠镜非透视下自扩张金属支架在处理梗阻性结直肠癌中的临床应用研究[J].中华航海医学与高气压医学杂志, 2016, 23(4):293-297.
[4]韦振轩,陈小勋. X线辅助内镜置入支架联合腹腔镜手术治疗结直肠癌并梗阻的疗效分析[J].中国普通外科杂志, 2016, 25(4):475-480.
[5]石磊,赵伟,周宇,等.肠道支架置入术与急诊手术治疗急性梗阻性结直肠癌疗效的Meta分析[J].中国全科医学, 2016, 19(8):941-945.
[6]程云飞.腹腔镜联合肠镜下支架置入治疗结直肠癌合并肠梗阻37例临床观察[J].中国临床医生杂志, 2016, 44(12):75-77.
[7] PARK SJ, LEE KY, KWON SH, et al. Stenting as a bridge to surgery for obstructive colon cancer:does it have surgical merit or oncologic demerit[J]. Annals of Surgical Oncology, 2016, 23(3):842-848.
[8]陈俊杰,赖亚栋,李东升,等.肠道支架及肠梗阻导管治疗急性左半结直肠癌性梗阻的研究[J].中华消化内镜杂志, 2016, 33(4):252-254.
[9]方日,王小文. CDH1基因甲基化状态与结直肠癌临床病理特征及预后的相关性研究[J].海南医学, 2016, 27(11):1779-1782.
[10]靳红绪,黄立宁,王忠义,等.加速康复外科策略对腹腔镜结直肠癌手术患者术后恢复的影响[J].临床麻醉学杂志, 2016, 32(12):1149-1153.
[11]叶刚,朱贤林,吴述轩,等.盐酸右美托咪定对腹腔镜结直肠癌根治术患者麻醉苏醒质量的影响[J].医药导报, 2017, 36(2):175-178.
[12]杨悦,马铃,代玉婷,等.盐酸右美托咪定对开腹结直肠癌根治术患者围术期肺动态顺应性和外周血中TLR-2和TLR-4表达的影响[J].中国医科大学学报, 2016, 45(12):1077-1081.
[13]汪少华,李玲,郭翠华,等.空气压力治疗仪结合低相对分子质量肝素预防结直肠癌术后深静脉血栓形成的效果[J].血栓与止血学,2017, 23(2):308-309.
[14]张娜,李志霞,肖慧杰,等.经内镜植入自膨式金属支架治疗结直肠癌性梗阻的安全性与有效性分析[J].实用癌症杂志, 2016, 31(7):1101-1104.
[15]冯凯瑜,范明娟,谭荣荣,等.粪便中MGMT,p16INK4A及ECAD基因启动子甲基化检测在结直肠癌诊断中的价值[J].海南医学,2016, 27(21):3461-3463.
[16]赵鹏,白鍊,李启刚,等.梗阻性结直肠癌中E-cadherin、CD44v6的表达及与预后的关系[J].第三军医大学学报, 2016, 38(6):629-633.
[17]刘晖,朱贤章.置入支架后择期手术与急诊手术在梗阻性结直肠癌中的对比研究[J].中国现代普通外科进展, 2017, 20(3):184-187.
[18]刘英俊,王刚成,万相斌,等.带蒂大网膜预防梗阻性结直肠癌术后吻合口瘘的疗效[J].中华普通外科杂志, 2017, 32(1):23-25.
[19]宋冰,张文婧,李东印,等.经肛门肠梗阻导管联合腹腔镜手术治疗左半梗阻性结直肠癌的效果研究[J].中国急救医学, 2016, 36(1):110-111.
[20] FERRONI P, SPILA A, MARTINI F, et al. Prognostic value of vascular endothelial growth factor tumor tissue content of colorectal cancer.[J]. Oncology, 2016, 69(2):145-153.
[21]石洋,张锡朋,许晨,等.经鼻肠梗阻导管治疗老年结直肠癌术后炎性早期肠梗阻[J].中国中西医结合外科杂志, 2016, 22(6):586-588.
[22]张全超,孙学军.自膨式金属支架对结直肠癌合并肠梗阻患者术后疼痛及恢复质量的影响[J].国际消化病杂志, 2016, 36(6):381-383.