天津医药

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结肠镜下金属肠道支架与经肛肠梗阻导管治疗左半结直肠癌急性梗阻的临床研究

陈震1,王西墨2,尹注增3,4,王效民3,4   

  1. 1. 天津市南开医院外科急诊
    2. 天津市南开医院
    3. 天津市人民医院
    4. 天津市人民医院
  • 收稿日期:2013-12-24 修回日期:2014-02-21 出版日期:2014-05-15 发布日期:2014-05-15
  • 通讯作者: 王西墨

The Clinical Study About Colonoscopic Metal Stenting And Ileus Tube Catheterization In The Therapy For Left Colorectal Cancer With Acute Obstruction

  • Received:2013-12-24 Revised:2014-02-21 Published:2014-05-15 Online:2014-05-15

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摘要： 【摘要】目的 探讨结肠镜下金属支架与经肛肠梗阻导管治疗左半结直肠癌急性梗阻的临床疗效。方法 回顾性研究我院2011年8月至2013年12月，符合诊断标准的左半结直肠癌急性梗阻患者共80例，分为支架组和导管组，各40例。两组均在结肠镜并X线辅助下进行，支架组放置金属肠道支架治疗，导管组经肛放置肠梗阻导管治疗。待梗阻消失后（7~10d），患者行一期肿瘤根治性切除并吻合。对比研究两组技术操作、肠梗阻改善情况以及手术治疗效果。结果 两组技术上相比，支架组成功率为87.5%，导管组为97.5%，P>0.05，无统计学差异，且均未出现并发症；但支架组操作时间及费用均明显高于导管组。从梗阻缓解情况相比，两组患者梗阻缓解率分别为100%和95%，P>0.05，但导管组2例患者因梗阻未能缓解，行急症手术治疗。此外，支架组梗阻缓解时间及C反应蛋白差值均优于导管组。梗阻缓解后，两组患者行一期肿瘤根治切除并吻合，均未出现吻合口瘘。并且手术时间、切口感染率和住院时间也无显著差异。结论 上述两种方案均可作为治疗左半结直肠癌急性梗阻的安全有效手段，并能达到一期根治性切除和吻合，降低围手术期并发症发病率。但经肛肠梗阻导管治疗卫生经济学价值更优；而从肠梗阻改善情况角度考虑，选择肠道金属支架在一定程度上优于经肛肠梗阻导管。

关键词: 金属支架, 经肛肠梗阻导管置入术, 左半结直肠癌, 急性肠梗阻

Abstract: [Abstract] Objective To discuss the clinical efficacy between colonoscopic metal stenting and ileus tube catheterization in the therapy for left colorectal cancer with acute obstruction. Methods Clinical data of 80 cases applied metal stents and ileus tube to treat with left colonic cancer of our hospital from august,2011 to december,2013 was retrospectively analyzed.The 80 cases who met the diagnostic criteria were devided into metal stent group (40 cases) and ileus tube group (40 cases). The two groups were carried on by colonoscopy and X- line. The metal stent group were treated by metal stent and the ileus tube group were treated by ileus tube. After obstruction disappear (7~10d), two treatment groups were all implemented colorectal cancer radicalresection and anastomosis.To compare the technical operation, improvement of obstruction and effect of surgical treatment. Results Technical comparison in two groups , The success rate of the metal stent group was 87.5%, the success rate of ileus tube group was 97.5%，P>0.05.Both of two groups did not appear developed complications.But the operation time and cost of metal stent group were more than ileus tube group. Obstruction relief in two groups, Obstruction of remission rate of metal stent group was 100%,the other group was 95%，P>0.05,while 2 cases in ileus tube group were emergency operated because of failure of obstruction relief.Besides, both the time of obstruction ease and the difference between c - reactive protein of metal stent group were superior to ileus tube group. After obstruction disappear, two treatment groups were all implemented colorectal cancer radicalresection and anastomosis, both of two groups did not appear anastomotic leakage,and there were not difference in operative time, infection rate and hospitalization time. Conclusion Both of two methods can treat with left colonic cancer safely and effectively,be implemented colorectal cancer radicalresection and anastomosis,and reduce the incidence of perioperative complications.But in Health Economics ,the ileus tube is better ,while in obstruction relief aspect, the metal stent is better. [key words] metal stent；the anal ileus tube catheterization；left colorectal cancer；acute obstruction

Key words: metal stent, the anal ileus tube catheterization, left colorectal cancer, acute obstruction