CAJ | 학술논문

目的探讨自扩张金属支架(SEMS)在可切除的左侧结肠癌(或直肠癌)合并急性肠梗阻中的治疗价值.方法回顾性分析2007年5月至2012年1月首都医科大学附属北京朝阳医院普外科收治的73例左侧结肠癌(或直肠癌)合并急性肠梗阻患者,按治疗方法的不同分为SEMS组(34例)和急诊手术组(39例).SEMS组患者均先放置SEMS解除梗阻,再限期手术.比较2组患者的一期切除吻合率、肠造口率、腹腔镜手术率、术后病死率和总并发症率、ICU住院率、ICU停留时间、住院时间和住院费用.结果 SEMS组患者一期切除吻合率(97.1％)明显高于急诊手术组(56.4％)(x2=16.256,P＜0.01),而保护性造口率(33.3％)和永久性造口率(2.9％)均低于急诊手术组(分别为86.3％、43.6％)(x2=14.972、16.156,P＜0.001).SEMS组接受腹腔镜手术的患者(47.1％)明显多于急诊手术组(0)(x2=23.505,P＜0.001).2组患者术后病死率(SEMS组2.9％,急诊手术组10.3％)的差异无统计学意义.SEMS组术后总并发症率为35.3％,低于急诊手术组(66.7％)(x2 =7.163,P=0.007),切口感染率(17.6％)低于急诊手术组(38.5％),但差异无统计学意义(x2=3.840,P =0.050).与急诊手术组比较,SEMS组术后ICU住院率(24.2％)低(x2=6.972,P=0.008),ICU停留时间[(69.5±7.4)h]短(t=-20.23,P＜0.001),平均住院时间[(19.6±4.8)d]少(t=-2.90,P=0.005),平均住院费用[(45383±15648)元]低(t=-3.74,P＜0.001).结论SEMS可有效解除左侧结肠癌(或直肠癌)合并的急性肠梗阻,将急诊手术转变为限期手术,从而获得更好的术后结果,具有良好的应用价值.
목적 탐토자확장금속지가(SEMS)재가절제적좌측결장암(혹직장암)합병급성장경조중적치료개치.방법 회고성분석2007년5월지2012년1월수도의과대학부속북경조양의원보외과수치적73례좌측결장암(혹직장암)합병급성장경조환자,안치료방법적불동분위SEMS조(34례)화급진수술조(39례).SEMS조환자균선방치SEMS해제경조,재한기수술.비교2조환자적일기절제문합솔、장조구솔、복강경수술솔、술후병사솔화총병발증솔、ICU주원솔、ICU정류시간、주원시간화주원비용.결과 SEMS조환자일기절제문합솔(97.1％)명현고우급진수술조(56.4％)(x2=16.256,P＜0.01),이보호성조구솔(33.3％)화영구성조구솔(2.9％)균저우급진수술조(분별위86.3％、43.6％)(x2=14.972、16.156,P＜0.001).SEMS조접수복강경수술적환자(47.1％)명현다우급진수술조(0)(x2=23.505,P＜0.001).2조환자술후병사솔(SEMS조2.9％,급진수술조10.3％)적차이무통계학의의.SEMS조술후총병발증솔위35.3％,저우급진수술조(66.7％)(x2 =7.163,P=0.007),절구감염솔(17.6％)저우급진수술조(38.5％),단차이무통계학의의(x2=3.840,P =0.050).여급진수술조비교,SEMS조술후ICU주원솔(24.2％)저(x2=6.972,P=0.008),ICU정류시간[(69.5±7.4)h]단(t=-20.23,P＜0.001),평균주원시간[(19.6±4.8)d]소(t=-2.90,P=0.005),평균주원비용[(45383±15648)원]저(t=-3.74,P＜0.001).결론SEMS가유효해제좌측결장암(혹직장암)합병적급성장경조,장급진수술전변위한기수술,종이획득경호적술후결과,구유량호적응용개치.
Objective To investigate the therapeutic value of self-expanding metallic stent (SEMS)for resectable obstructing left-sided colon cancer or rectal cancer.Methods Clinical data of 73 patients who had acute obstruction due to left-sided colon cancer or rectal cancer during May 2007 to January 2012 were retrospectively analyzed.The patients were divided into 2 groups:SEMS group (34 cases) underwent surgical resection after insertion of SEMS; emergency surgery group (39 cases) underwent emergency operation.The 2 group patients were compared for the incidence of primary anastomosis,stoma rate,laparoscopic surgery rate,mortality,postoperative morbidity,ICU admission rate,length of ICU stay,hospital stay,and hospitalization costs.Results The incidence of primary anastomosis in SEMS group was significantly higher than that in emergency surgery group (97.1％ vs.56.4％,x2 =16.256,P ＜0.001 ),and the protective stoma rate and permanent stoma rate in SEMS group were both lower than those in emergency surgery group (33.3％ vs.86.3％,2.9％ vs.43.6％,x2 value were 14.972 and 16.156,both P ＜0.001 ).Patients in SEMS group underwent significantly more laparoscopic surgery than in emergency surgery group(47.1％ vs.0,x2 =23.505,P ＜0.001 ).There were no significant difference in postoperative mortality (2.9％ vs.10.3％,P =0.364).The postoperative morbidity in SEMS group was significantly lower than that in emergency surgery group (35.3％ vs.66.7％,P=0.007).Incisional infection was the most common complication in both groups,and the incidence of which seemed to be more higher in emergency surgery group ( 17.6％ vs.38.5％,x2 =3.840,P =0.050).There was a lower ICU admission rate in SEMS group (24.2％ vs.53.9％,x2 =6.972,P =0.008),and the mean length of ICU stay and hospital stay were both shorter in SEMS group ( ( 69.5 ± 7.4 ) hours vs.( 114.3 ± 10.9 ) hours,t =-20.23,P＜0.001; (19.6±4.8) days vs.(23.4±6.2) days,t=-2.90,P=0.005).The cost of hospitalization was less in SEMS group (45383 ± 15648 vs.61485 ± 20380,t =- 3.74,P ＜ 0.001 ).Conclusions SEMS can effectively relieve the large intestinal obstruction caused by left-sided colon cancer or rectal cancer,and change the traditional emergency surgery into a selective surgery with better outcomes.SEMS appears to be a valuable technique for resectable obstructing left-sided colorectal cancer.