结直肠癌致急性梗阻内镜支架治疗后再手术临床观察

目的探讨结直肠癌致急性梗阻内镜支架治疗后再手术的临床效果。方法对两家医院36例结直肠癌致急性梗阻患者行内镜支架治疗,观察内镜支架治疗的成功率、疗效和并发症;对30例患者内镜支架治疗后接受再手术治疗,手术前后血清CRP水平变化、血清ALB水平变化、肿瘤周围组织病理变化、肿瘤根治性切除率、吻合口一期吻合率、近端肠造口率、清扫淋巴结数、术后肠功能恢复时间、术后并发症发生率、术后肿瘤复发率和术后生存率等指标,与同期30例急诊手术组患者比较。结果 33例放置内镜支架成功,成功率91.7%,支架治疗后6-12小时肠梗阻缓解,血清CRP明显下降,血清ALB升高,肠管扩张明显缓解,肿瘤周围组织黏连水肿消退。两组患者术前血清CRP分别为(26.3±9.5)mg/L和(133.4±25.2)mg/L;血清ALB分别为(34.6±6.1)g/L和(28.4±5.8)g/L,肿瘤根治性切除率分别为73.3%(22/30)和36.7%(11/30);吻合口一期吻合率分别为81.8%(18/22)和36.4%(4/11);近端肠造口率分别为46.7%(14/30)和80.0%(24/30);清扫淋巴结数分别为(10.7±4.3)个/例和(6.4±2.5)个/例;术后肠功能恢复时间分别为(4.3±1.6)天和(5.6±2.2)天;术后并发症发生率分别为13.3%(4/30)和53.3%(16/30)。两组比较,差异均有统计学意义。结论结直肠癌致急性梗阻内镜支架治疗能迅速解除梗阻,再手术时全身情况和肿瘤局部环境明显改善,肿瘤根治性切除率升高,手术风险和术后并发症降低,疗效改善,值得临床推广应用。

Treatment effect of surgical operation after stent placement through colonoscopy for acute intestinal obstruction caused by colorectal neoplasm

Objective To research the clinical effect of surgical operation after stent placement through colonoscopy for acute intestinal obstruction caused by colorectal neoplasm. Methods Thirty-six patients in two hospitals suffering acute intestinal obstruction caused by colorectal neoplasm received stent placement through colonoscopy.The success rate,the treatment effect and the complications were observed.Thirty patients accepted surgical operation after stent placement though colonoscopy successfully.By comparison with the 30 cases in the emergency surgery group,the preoperative and postoperative levels of CRP and ALB in serum,the pathological change of the tissue around neoplasm,the radical resection rate of neoplasm,the one-stage anastomosis rate,the enterostomy rate,the number of dissected lymph nodes,the postoperative recovery time of intestinal function,the incidence of postoperative complications,the recurrence rate and the survival rate after operation were studied. Results Thirty-three patients accepted stent placement though colonoscopy successfully.In this group,the success rate of stent placement though colonoscopy was 91.7%.Symptoms of intestinal obstruction relieved 6 to 12 hours after the treatment.The CRP level in serum decreased and the ALB level in serum increased significantly.Edema and adhesion of the tissue around neoplasm reduced and the expanded bowel relieved significantly.The preoperative CRP concentrations in serum of the two groups were（26.3±9.5）mg/L and（133.4±25.2）mg/L,the preoperative ALB concentrations of the two groups were（34.6±6.1）g/L and（28.4±5.8）g/L.In two groups the radical resection rate of neoplasm was 73.3%（22/30） and 36.7%（11/30）;the one-stage anastomosis rate was 81.8%（18/22） and 36.4%（4/11）;the enterostomy rate was 46.7%（14/30） and 80.0%（24/30）;the average number of dissected lymph nodes was（10.7±4.3） per patient and（6.4±2.5） per patient;the postoperative recovery time of intestinal function was（4.3±1.6） days and（5.6±2.2） days;the incidence of postoperative complications was 13.3%（4/30） and 53.3%（16/30）,respectively.There were significant statistical differences between the two groups. Conclusions Stent placement through colonoscopy for acute intestinal obstruction caused by colorectal neoplasm could relieve obstruction rapidly.The general condition and the local environment around the lesion can be improved apparently,the operational risk and the incidence of postoperative complications decreased,and the radical treatment effect increased.