自膨式金属支架及手术解除晚期结直肠癌肠梗阻的疗效比较

背景：对于发生梗阻的晚期结直肠癌患者，置入金属支架的治疗效果尤其是远期疗效知之甚少。 目的：比较自膨式金属支架和姑息性手术解除晚期结直肠癌患者肠梗阻的疗效。 方法：纳入采用自膨式金属支架和姑息性手术两种治疗方式的186例患者，回顾性分析两组患者性别、年龄、梗阻部位、转移部位、支架类型、支架直径、术后并发症、住院时间、化疗、手术至初次化疗时间和晚期梗阻等资料。 结果与结论：支架组的技术成功率低于手术组(P=0.030)，临床成功率无差异。与手术组比较，支架组并发症发生率较低，但是主要并发症发生率比较，差异无显著性意义(P=0.839)。支架组住院时间、手术到化疗时间均比较短，但其晚期梗阻的发生率明显高于手术组(P=0.028)。Logistic多元回归分析发现，支架直径和化疗是影响晚期梗阻的独立危险因素。说明对于无法切除并发梗阻的结直肠癌患者支架置入治疗具有更好的早期疗效，但是长期疗效较差，尤其是放置支架直径较小的化疗患者，可能需要再次放置支架或手术以解除晚期梗阻。

Effect of self-expanding metal stents versus surgery therapy for malignant colorectal obstruction in patients with advanced colorectal cancers

BACKGROUND:Little is known about the outcomes of stent therapy for relief of malignant colorectal obstruction in advanced colorectal cancer patients, especially for the long-term outcomes. OBJECTIVE:To compare the effect of self-expanding metal stent and palliative surgery in advanced colorectal cancer patients with malignant colorectal obstruction. METHODS:Totally 186 patients with incurable obstructive colorectal cancers who underwent self-expanding metal stent and palliative surgery were included. Information including sex, age, obstruction sites, metastatic sites, type of stent, diameter of stent, postoperative complications, length of hospital admission, chemotherapy, time to chemotherapy administration and late obstruction were retrospective analyzed. Short-term and long-term outcomes were compared between the two groups. Multivariate logistic regression analysis was used to estimate the strength of association between late obstruction and various factors. RESULTS AND CONCLUSION:The technical success rate in the stent group was lower than that in the surgery group (P=0.030), and the rates of clinical success in the two groups had no difference. The stent group had fewer postoperative complications than the surgery group, but the rates of major complications had no difference between the two groups (P=0.839). The stent group had a shorter time in length of hospital admission and time to chemotherapy administration, but a higher rate of late obstruction as compared with the surgery group (P=0.028). Diameter of stent and chemotherapy were independent risk factors for late obstruction. These findings indicate that the self-expanding metal stent is an effective therapy with a better early outcome for malignant colorectal obstruction, but it has a worse long-term outcome than palliative surgery, especially for chemotherapy patients with a smaller diameter of stent, who may need stent reinsertion or a second surgery to relieve late obstruction.