文章摘要
孙 超,徐芳媛,袁志萍,尹成龙,朱 叶,施瑞华,杨树平,于莲珍.支架置入后择期手术与急诊手术治疗结直肠恶性梗阻临床价值的对比研究[J].南京医科大学学报,2014,(5):653~659
支架置入后择期手术与急诊手术治疗结直肠恶性梗阻临床价值的对比研究
Clinical value of comparative study between elective surgery after stenting and emergency surgery of colorectal malignant obstruction
投稿时间:2013-07-29  
DOI:10.7655/NYDXBNS20140524
中文关键词: 支架  结直肠癌  肠梗阻  择期手术  急诊手术  腹腔镜
英文关键词: stent  colorectal cancer  large-bowel obstruction  elective surgery  emergency surgery  laparoscopy
基金项目:
作者单位
孙 超 南京医科大学第一附属医院消化内科,江苏 南京 210029 
徐芳媛 南京医科大学第一附属医院消化内科,江苏 南京 210029 
袁志萍 南京医科大学第一附属医院消化内科,江苏 南京 210029 
尹成龙 南京医科大学第一附属医院消化内科,江苏 南京 210029 
朱 叶 南京医科大学第一附属医院消化内科,江苏 南京 210029 
施瑞华 南京医科大学第一附属医院消化内科,江苏 南京 210029 
杨树平 南京医科大学第一附属医院消化内科,江苏 南京 210029 
于莲珍 南京医科大学第一附属医院消化内科,江苏 南京 210029 
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中文摘要:
      目的:探讨内镜联合X线置放金属支架后择期手术与急诊外科手术相比,两者治疗可切除性结直肠恶性梗阻的临床价值及安全性?方法:回顾性分析2001年5月~2012年10月本院94例结直肠恶性梗阻患者的临床资料?其中30例经内镜联合X线临时置入金属支架,择期行手术治疗;64例行急诊手术治疗?比较支架组与急诊手术组的一期切除吻合率?手术时间?术后通气时间?住院时间?并发症发生率及住院期间病死率等指标并观察支架置入操作成功率?临床缓解率?并发症发生率及置入后接受剖腹手术和腹腔镜手术情况?结果:①支架组一期切除吻合率明显高于急诊手术组(96.67% vs 53.13%,P < 0.001)?支架组术后并发症明显低于急诊手术组(6.67% vs 25.00%,P < 0.05)?支架组住院期间病死率与急诊手术组相比,无统计学差异(P > 0.05)?支架组手术时间?术后通气时间分别为(156.13 ± 49.79)min,(3.60 ± 1.40)d,明显低于急诊手术组?支架组住院时间与急诊手术组相比,无统计学差异(P > 0.05);②支架组中30例放置金属支架,操作成功率100%(30/30),临床缓解率96.67%(29/30),并发症发生率6.67%(2/30),支架置入后平均(8.9 ± 1.0)d行择期手术?支架组接受腹腔镜手术的患者明显多于急诊手术组(P < 0.01)?支架组中剖腹手术的手术时间短于微创腹腔镜术(P < 0.05),剖腹术后并发症明显低于微创腹腔镜术(P < 0.05),但剖腹术患者的住院时间明显长于腹腔镜术的患者(P < 0.05)?结论:内镜联合X线置放金属支架可迅速?有效缓解结直肠恶性梗阻症状?经支架置入后择期手术与急诊手术相比安全性高,且增加一期切除吻合率,并减少并发症,可作为缓解结直肠恶性梗阻的一项有效治疗方法?剖腹手术仍是结直肠恶性梗阻支架置入后的主要手术方式?通过支架置入,可使部分患者获得微创手术机会?
英文摘要:
      Objective:To evaluate the clinical value and safety of colorectal stenting as a bridge to primary anastomosis placed endoscopically using fluoroscopic guidance versus emergency surgical decompression on acute resectable malignant colorectal obstruction. Methods:From May 2001 to October 2012,94 patients were diagnosed with acute colorectal malignant obstruction. Thirty patients underwent metal stent placement as a bridge to an elective resection and primary anastomosis,while 64 patients underwent emergency surgery. The two group were compared for successful one-stage operation,operation time,postoperative ventilation time,hospital stay,hospital mortality and postoperative complications. And the clinical and technical success rate of stent placement,the rate of stent-related complication and after stenting accept laparotomy and laparoscopic surgery in the stent group was analyzed. Results:There was a significant difference in successful one-stage operation and morbidity between two groups. A resection and anastomosis stent group was significantly higher than emergency surgery group (96.67% vs 53.13%,P < 0.001). The postoperative morbidity in stent group was significantly lower than that in emergency surgery group (6.67% vs 25.0%,P < 0.05). There was no statistically significant difference in mortality rate in both groups. In stent group,operative time,postoperative ventilation time was (156.13 ± 49.79) min,(3.60 ± 1.40) d,which were significantly lower than those of the emergency surgery group. The stent group had no significant difference on hospital stay compared with emergency surgery group(P > 0.05). The stent insertion was 100% successful in attempted stent placements. The clinical success rate was 96.67% in the stent group. The stent-related complication was 6.67%. The mean interval between stenting and surgery was(8.9 ± 1.0)d. Patients in the sent group underwent significantly more laparoscopic surgery than in emergeney surgery group(P < 0.01). Surgery time stent group undergoing laparotomy is shorter than the stent group undergoing laparoscopic surgery (P < 0.05),laparotomy complications was significantly lesser than the minimally invasive laparoscopic surgery in the sent group (P < 0.05),but received laparotomy patient's hospital stay was significantly longer than patients undergoing laparoscopic surgery. Conclusion:Colorectal stenting placed endoscopically using fluoroscopic guidance as a bridge to a primary surgical procedure is effective. Elective surgery after stenting is more safer than emergency surgery. Elective surgery could increase the chance of primary anastomosis,and reduce postoperative complications,and can be used as an effective treatment for remission of malignant colorectal obstruction. Laparotomy is still the main choice after stenting for elective surgery. By stent implantation,patients can get the opportunity of minimally invasive surgery.
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