实用医学杂志 ›› 2022, Vol. 38 ›› Issue (1): 79-84.doi: 10.3969/j.issn.1006⁃5725.2022.01.015

• 临床研究 • 上一篇    下一篇

支架置入后择期手术与急诊手术治疗急性右半结肠恶性梗阻临床疗效比较

李鹏莉1 石定2   

  1. 1 河南中医药大学(郑州450046),2 中国科学院大学宁波华美医院(浙江宁波315000)

  • 出版日期:2022-01-10 发布日期:2022-01-10
  • 通讯作者: 石定 E⁃mail:shidingyuhang@163.com

The efficacy of elective surgery after stent implantation versus that of emergency surgery for acute malig⁃ nant obstruction of the right hemicolon

LI Pengli*,SHI Ding.   

  1. He′nan University of Chinese Medicine,Zheng⁃ zhou 450046,China

  • Online:2022-01-10 Published:2022-01-10
  • Contact: SHI Ding E⁃mail:shidingyuhang@163.com

摘要:

目的 本研究旨在比较支架置入术后择期手术与急诊手术治疗急性右半结肠恶性梗阻的 临床价值和远期预后。方法 选取 2010 1 月至 2018 5 月在中国科学院大学宁波华美医院因急性右半结肠恶性梗阻行支架置入后择期手术的 25 例患者作为病例组(支架组)。以年龄、性别、肿瘤大小和位 置以及 TNM 分期 5 个协变量作为患者的基线特征。采用 1∶2 最邻近匹配法匹配该院同时期因急性右半结 肠恶性梗阻行急诊手术的 230 例患者,以均衡两组患者的协变量。经倾向评分匹配后,急诊手术组纳入 50 例患者。结果 支架置入术治疗急性右半结肠恶性梗阻的技术成功率和临床成功率分别为 100% 96.0%。支架组接受腹腔镜手术的比例明显高于急诊手术组,平均手术时间明显低于急诊手术组,差异具 有统计学意义(P < 0.05)。与急诊手术组相比,支架组术后并发症发生率明显降低,术后住院时间明显缩 短,差异均具有统计学意义(P < 0.05)。两组间术后 30 d 死亡率、5 年无病生存率和总生存率对比差异均 无统计学意义(P > 0.05)。结论 支架置入术治疗急性右半结肠恶性梗阻具有一定的安全性和可行性。 支架置入术作为外科手术的桥梁,可增加急性右半结肠恶性梗阻患者接受微创手术的机会,缩短手术时间,降低患者并发症发生率、缩短住院时间,可作为治疗急性右半结肠梗阻的一项选择。

关键词:

支架, 右侧结肠癌, 急性肠梗阻, 择期手术, 急诊手术

Abstract:

Objective The purpose of this study was to compare the clinical value and long⁃term progno⁃ sis of elective surgery after stent implantation with those of emergency surgery in the treatment of acute malignant obstruction of the right hemicolon. Methods 25 patients who had undergone elective surgery after stenting for acute malignant obstruction of right hemicolon from January 2010 to May 2018 in Ningbo Huamei Hospital,Univer⁃ sity of Chinese Academy of Sciences were selected as a case group(stent group). Age,gender,tumor size and loca⁃ tion and TNM stage were used as the baseline characteristics of patients. The 1∶2 nearest neighbor⁃matching meth⁃ od was used to match 230 patients who had received emergency surgery for acute malignant obstruction of the right colon during the same period,which balanced the covariates in the two groups. After being matched via propensity score,50 patients were included in an emergency operation group. Results The technical success rate of stent implantation for acute malignant obstruction of the right hemicolon was 100% while the clinical success rate was 96.0%. The proportion of laparoscopic surgery was significantly higher but the surgical duration was markedly shorter in the stent group than in the emergency operation group(< 0.05). As compared with the emergency operation group,the incidence of postoperative complications and the length of postoperative hospital stay were significantly reduced in the stent group(< 0.05). There were no significant differences in 30⁃day mortality,5⁃year disease⁃free survival and overall survival between the two groups(> 0.05). Conclusions Stent implantation is safe and feasible in the treatment of acute malignant obstruction of the right hemicolon. As a bridge of surgery,stent implan⁃ tation can increase the chance of minimally invasive surgery for patients with acute right hemicolon malignant obstruction,shorten the surgical duration and the length of hospital stay,and reduce the incidence of complications. It can be used as an option for the treatment of acute right hemicolon obstruction.

Key words:

stent, right colon cancer, acute intestinal obstruction, elective surgery, emergency surgery