自膨胀式肠道支架在结直肠癌合并急性肠梗阻中的应用
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摘要
探讨经内镜放置的自膨胀式肠道金属支架在结直肠癌合并急性肠梗阻治疗中的临床疗效。分析2014年9月—2017年3月实施的130例结直肠癌合并急性肠梗阻患者的临床资料,急诊开腹手术60例为对照组,经内镜自膨胀式肠道金属支架置入术70例为观察组,比较两组患者一期手术切除吻合率、术后并发症发生率及术后恢复情况。对照组术后并发症发生率(2.3%,1 7/60)高于观察组(7.1%,5/70);观察组一期吻合率(92.9%,65/70)高于对照组(80%,48/60);观察组平均住院时间短于对照组[(10.20±2.72)d vs(16.35±7.32)d];观察组术后恢复胃肠蠕动时间短于对照组[(3.56±1.51)d vs(5.68±2.34)d],术后腹腔引流时间少于对照组[(7.25±2.23)d vs(10.31±2.74)d],差异均有统计学意义(P <0.05)。随访1年,对照组因腹腔肿瘤广泛转移死亡2例,观察组无死亡病例。对结直肠癌合并急性肠梗阻患者经内镜置入自膨胀式肠道金属支架,能够快速解决肠梗阻临床症状,有效减轻肠道水肿程度,有助于提高患者一期手术吻合率,减少术后并发症,提高生活质量。
引文
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[5]胡民辉,黄榕康,赵日升,等.新辅助放化疗联合腹腔镜治疗中低位直肠癌的短期疗效Meta分析[J].中国临床医生,2014,42(6):45-49.
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[8]宋树祥,陈平.肠道支架植入术在梗阻性结肠肿瘤中的应用[J].中国现代普通外科进展,2014,17(5):375-378.
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[10]黄美贞.晚期结肠癌患者行姑息性支架置入治疗与手术治疗的比较[J].中国普外基础与临床杂志,2010,17(3):288.
[11]Khot UP,Lang AW,Murali K,et al.Systematic review of the efficacy and safety of colorectal stents[J].Br J Surg,2002,89(9):1096-1102.
[12]Chung TS,Lim SB,Sohn DK,et al.Feasibility of single-stage laparoscopic resection after placement of a self-expandable metallicstent for obstructive left colorectal cancer[J].World J Surg,2008,32:2275-2280.
[13]曹燕,刘冰妍,茅爱武,等.急性结肠梗阻支架置入对结直肠癌择期手术的作用[J].介入放射学杂志,2011,20(10):799-802.
[2]吴阶平,裘法祖.梗阻性结肠癌的手术处理[A].黄家驷外科学[M].6版.中册.北京:人民卫生出版社,2005:1140.
[3]Durán Giménez-Rico H,Abril Vega C,Herreros Rodríguez J,et al.Hartmann's procedure for obstructive carcinoma of the left colon and rectum:a comparative study with one-stage surgery[J].Clin Transl Oncol,2005,7(7):306-313.
[4]郭英辉,张啸.金属内支架治疗老年恶性肠梗阻的疗效和安全性[J].中国老年学杂志,2012,32(9):4051-4053.
[5]胡民辉,黄榕康,赵日升,等.新辅助放化疗联合腹腔镜治疗中低位直肠癌的短期疗效Meta分析[J].中国临床医生,2014,42(6):45-49.
[6]岳亮,梁小波.腹腔镜结直肠癌手术的研究进展[J].中国医学前沿杂志(电子版),2012,4(5):76-80.
[7]尹慕军,叶颖江,姜可伟,等.腹腔镜结直肠癌手术临床疗效探讨[J].中国医药,2010,5(1):60-62.
[8]宋树祥,陈平.肠道支架植入术在梗阻性结肠肿瘤中的应用[J].中国现代普通外科进展,2014,17(5):375-378.
[9]Ernández-Esparrach G,Bordas JM,Giráldez MD,et al.Severe complications limit long-term clinical success of self-ex-panding metal stents in patients with obstructive colorectal cancer[J].Am JGastroenterol,2010,105(5):1087-1093.
[10]黄美贞.晚期结肠癌患者行姑息性支架置入治疗与手术治疗的比较[J].中国普外基础与临床杂志,2010,17(3):288.
[11]Khot UP,Lang AW,Murali K,et al.Systematic review of the efficacy and safety of colorectal stents[J].Br J Surg,2002,89(9):1096-1102.
[12]Chung TS,Lim SB,Sohn DK,et al.Feasibility of single-stage laparoscopic resection after placement of a self-expandable metallicstent for obstructive left colorectal cancer[J].World J Surg,2008,32:2275-2280.
[13]曹燕,刘冰妍,茅爱武,等.急性结肠梗阻支架置入对结直肠癌择期手术的作用[J].介入放射学杂志,2011,20(10):799-802.