结肠内支架联合腹腔镜结肠癌根治术在结肠癌合并急性梗阻中的短期及中期疗效分析

目的:探讨结肠腔内支架置入联合腹腔镜下结肠癌根治术治疗结肠癌合并急性梗阻的短期及中期疗效。方法:选取2010年4月至2013年6月成功接受结肠腔内支架置入后行腹腔镜下结肠癌根治术的56例结肠癌合并急性梗阻患者(治疗组);另检索62例同期接受急诊开腹结肠癌根治术的结肠癌并急性梗阻患者作为对照(对照组)。对比两组患者的短期疗效指标及中期肿瘤学生存指标。结果:与对照组相比,治疗组术中出血量减少[(55.2±31.0)ml vs.(113.6±73.0)ml],淋巴结清扫数量增加[(20.0±5.1)vs.(15.4±5.2)],术后住院时间缩短[(7.3±2.1)d vs.(11.6±3.2)d],造口率(8.9%vs.67.7%)、术后吻合口漏发生率(2.0%vs.15.0%)、切口感染率(3.6%vs.16.1%)均降低,差异有统计学意义(P0.05)。两组患者3年局部复发率(17.9%vs.19.4%)、3年无病生存率(64.3%vs.62.9%)、3年总体生存率(78.6%vs.75.8%)差异均无统计学意义(P0.05)。结论:结肠内支架联合腹腔镜下结肠癌根治术治疗结肠癌合并急性梗阻具有良好的短期及中期疗效。

The short-and mid-term efficacy of self-expanding metallic stent and radical laparoscopic colectomy in the curable colon cancer with acute obstruction

Objective:To investigate the short-and mid-term efficacy of self-expanding metallic stent and radical laparoscopic colectomy in the curable colon cancer with acute obstruction.Methods:Fifty-six patients with colonic carcinoma and acute obstruction received self-expanding metallic stent placement and radical laparoscopic colectomy between Apr.2010 and Jun.2013 ( therapy group) . And 62 patients with colon cancer and acute obstruction were treated by conventional emergency open surgery in the same period ( con-trol group) .The short term clinical data and mid-term oncological survival data were compared between the two groups.Results:The therapy group revealed less blood loss in the operation [(55.2 ±31.0) ml vs.(113.6 ±73.0) ml],more dissected lymph nodes [(20.0 ±5.1) vs.(15.4 ±5.2)],shorter postoperative hospital stay [(7.3 ±2.1) d vs.(11.6 ±3.2) d],lower incidence of stoma (8.9%vs.67.7%),anastomotic leakage (2.0%vs.15.0%) and incision infection (3.6%vs.16.1%) than the control group (P<0.05).There were no significant differences in 3-year local recurrent rate (17.9% vs.19.4%),3-year disease-free survival (64.3%vs.62.9%) and 3-year overall survival (78.6% vs.75.8%) between the two groups (P>0.05).Conclusions:Self-ex-panding metallic stent and radical laparoscopic colectomy shows better short-term outcome and non-inferiority in mid-term oncological survival in the curable colon cancer and acute obstruction.