置入支架后择期手术与急诊手术治疗梗阻性结直肠癌的效果比较

摘要

目的 分析梗阻性结直肠癌患者内镜辅助下置入支架后采取择期手术或急诊手术的临床治疗效果.方法 选取2014年1月至2016年2月临汾市中心医院诊治的梗阻性结直肠癌患者102例,按照随机数字表法分为观察组和对照组,每组51例.两组患者均于腹内镜辅助下完成支架置入术,对照组行急诊手术,观察组行择期手术治疗.比较两组一期切除吻合率、腹腔镜手术治疗情况,围术期指标及术后并发症发生率、病死率.结果 观察组一期切除率、剖腹术率和腹腔镜手术率(96.08％、82.35％、17.65％)均高于对照组(54.90％、52.94％、1.96％),P<0.05;观察组手术用时、通气时间和住院时间[(152.47±12.37)min、(3.62±0.51)d、(17.26±1.43)d]均少于对照组[(181.43±16.95)min、(6.27±1.84)d、(19.58±2.37)d],P<0.05;观察组病死率及术后吻合口瘘、切口感染、肺部感染等并发症发生率(0.00％、1.96％、3.92％、1.96％)均低于对照组(3.92％、9.80％、11.76％、7.84％),P<0.05.结论 梗阻性结直肠癌患者置入支架后选择择期手术,能够降低其术后并发症发生率和病死率,提升一期切口吻合率,可作为优选术式应用并推广.%Objective To analyze the clinical effect of elective surgery and emergency surgery on patients with obstructive colorectal cancer after endoscopy-assisted stenting .Methods One hundred and two patients with obstructive colorectal cancer diagnosed and treated in Linfen Central Hospital from January 2014 to February 2016 were selected and divided into observation group and control group according to random number table method , with 51 cases in each group .All of the patients underwent endoscopy-assisted stenting . Patients in control group underwent emergency surgery after stent implantation , and patients in observation group underwent elective surgery .The anastomotic rate of first-stage resection , laparoscopic operation , perioperative indexes , incidence of complications and mortality were compared between the two groups .Results The first-stage resection rate , laparotomy rate and laparoscopic operation rate of observation group (96.08％, 82.35％, 17.65％) were significantly higher than those of control group (54.90％, 52.94％, 1.96％), P<0.05.Operation time, ventilation time and hospital stay in observation group was ( 152.47 ±12.37 ) min, ( 3.62 ±0.51 ) d and ( 17.26 ± 1.43)d, respectively, which were significantly better than (181.43 ±16.95)min, (6.27 ±1.84)d and (19.58 ±2.37)d in control group (P<0.05).The mortality and incidences of complications such as anastomotic leakage , incision infection and pulmonary infection in observation group (0.00％, 1.96％, 3.92％, 1.96％) were lower than those in control group ( 3.92％, 9.80％, 11.76％, 7.84％) , P<0.05.Conclusions Elective surgery for patients with obstructive colorectal cancer after implantation of stent can reduce incidence of postoperative complication and mortality , and improve the anastomotic rate of incision.Elective surgery can be applied and popularized as an optimum surgical method for patients with obstructive colorectal cancer .