结肠镜非透视下金属支架置入序贯手术治疗梗阻性结直肠癌的临床研究

摘要

Objective To compare the long-term oncologic outcomes of self-expanding metallic stents (self-expanding metallic stents,SEMS)as a bridge to surgery(SEMS group)with those of emergency surgery(ES group)for malignant colorectal obstruction (malignant colorectal obstruction,MCO).Methods Adopting the method of retrospective study.The clinical data of 60 patients with MCO who accepted operation treatment were collected.Twenty-seven patients who underwent semi-elective curative resection after endoscopic SEMS insertion were included in the SEMS group,thirty-three patients who underwent emergency curative surgery were included in ES group.The clinic pathologic characteristics and overall survival(overall survival,OS)were compared between the two groups.The multidisciplinary discussion and evaluation was given to all of all of these patients preoperative.Results There were no significant differences in general information,tumor stage,location,and histology between the SEMS group and the ES group.The median OS times were 37 months for the SEMS group and 23 months for the ES group.The proportions of patients who received postoperative adjuvant chemotherapy were comparable(SEMS group vs.ES group,70.4％ vs.45.5％;P ＞0.05).The long-term oncologic outcome did not significantly different between two groups in the 3-year OS rate (55.6％ vs.39.4％;P ＞ 0.05)and the 5-year OS rate (48.1％ vs.36.4％;P ＞ 0.05).Conclusion Long-term oncologic outcomes of SEMS insertion as a bridge to surgery for malignant colorectal obstruction is safe,effective and feasible.%目的 比较肠镜下金属支架(self-expanding metallic stents,SEMS)置入序贯手术与急诊手术(emergency surgery,ES)治疗梗阻性结直肠癌的远期肿瘤学效果.方法 接受手术治疗的梗阻性结直肠癌病人60例.将60例病人分成两组,ES组33例,接受急诊手术治疗;SEMS组27例,接受非透视下SEMS置入序贯手术.比较两组病人临床病理特征及总体生存率.所有病人术前均由多学科团队讨论、制定治疗方案.结果 两组病人一般资料、肿瘤分期、肿瘤部位等比较差异无统计学意义.SEMS组病人中位总体生存时间为37个月,ES组病人为23个月.SEMS组和ES组病人接受术后辅助化疗分别为70.4％和45.5％,术后3年总体生存率分别为55.6％和39.4％,5年总体生存率分别为48.1％和36.4％,两组比较差异均无统计学意义(P＞0.05).结论 SEMS置人序贯手术治疗梗阻性结直肠癌安全、可行,远期肿瘤学结果有效.