摘要
目的 探讨内镜下金属支架置入是否可以作为梗阻性结直肠癌的一种转化治疗，为择期腹腔镜根治术提供可能。方法 2012年6月至2016年8月，福建医科大学附属龙岩第一医院对63例梗阻性结直肠癌患者选用自体膨胀式金属支架，在影像引导下经内镜置于肿瘤致肠狭窄段；待梗阻症状完全消失后进行多学科团队评估以制定后续手术治疗策略。后续的手术包括开腹和腹腔镜两种方式。回顾性分析这组病例的临床资料，并比较两种术式术中及术后恢复情况。结果 63例患者男性30例，女性33例；年龄30~ 97（平均67）岁；升结肠癌3例，横结肠癌4例，降结肠癌12例，乙状结肠癌26例，直肠癌18例。经金属支架治疗后，1例（1.6%）于术后3 h出现乙状结肠穿孔，行急诊Hartmann手术。余62例梗阻症状消失，经多学科团队评估，10例（16.1%）因肿瘤远处转移或基础状况差无法耐受手术，进行姑息性化疗。52例患者于支架置入后7~20（平均10）d接受根治性手术，其中18例行开腹手术（开腹组，包括2例腹腔镜中转手术病例），34例行腹腔镜手术（腹腔镜组）。两组患者基线资料比较，差异无统计学意义（均P 〉 0.05）。两组患者均顺利完成肠切除肠吻合术，无一例行预防性肠造口。腹腔镜组较开腹组术后排气时间[（2.88 ± 1.06）d比（4.05 ± 2.43）d，P= 0.022]和术后住院时间[（7.85 ± 0.96）d比（9.82 ± 4.41）d，P= 0.002]明显缩短，但两组患者手术时间、术中出血量、淋巴结清扫数量及术后并发症发生率的差异均无统计学意义（均P 〉 0.05）。结论 内镜下金属支架的应用可有效解除结直肠癌梗阻症状，从而为择期根治性手术创造了条件；金属支架联合腹腔镜手术治疗梗阻性结直肠癌是安全可行的。
Objective To investigate the feasibility of endoscopic metallic stent as a bridge to elective laparoscopic surgery in patients with malignant colorectal obstruction.Methods Clinical data of 63 patients with obstructive colorectal cancer who underwent endoscopic metallic stent insertion under radiologic monitoring at the Longyan First Hospital between June 2012 and August 2016 were analyzed retrospectively. After complete remission of the obstruction, all the patients received multi-disciplinary team （MDT） evaluation to make the further treatment strategy. The subsequent surgery included open and laparoscopic procedures, and the short-term efficacy of these two procedures was compared.Results There were 30 male and 33 female patients with age of 30 to 90 （mean 67） years, including 3 cases of ascending colon cancer, 4 cases of transverse colon cancer, 12 cases of descending colon cancer, 26 cases of sigmoid cancer, and 19 cases of rectal cancer. Only one patient （1.6%） developed sigmoid perforation at 3 hours after stent placement, and underwent emergency laparotomy with Hartmann procedure. The remaining 62 patients had bowel movements. After MDT evaluation, 10 patients （16.1%） were treated with palliative chemotherapy because they were unfit for surgery or for diffuse distant metastases. A total of 52 patients underwent radical surgery after a mean interval from stent insertion of 10 days （7-20 days） , including open （n= 18, including two cases with conversion to open surgery） and laparoscopy （n= 34） . The baseline data between open and laparoscopy groups were similar （all P 〉 0.05） . Primary anastomosis was successfully performed in all the patients without preventive stoma. Compared to open group, laparoscopy group had faster bowel movement[ （2.88 ± 1.06） d vs. （4.05 ± 2.43） d, P= 0.022]and shorter postoperative hospital stay[ （7.85 ± 0.96） d vs. （9.82 ± 4.41） d, P= 0.002]. There were no statistically significant differences in operative time, intraoperative blood loss, number of harvested lymph node, and postoperative complication rate between two groups （all P 〉 0.05） .Conclusions Endoscopic metallic stent placement can effectively remove malignant colorectal obstruction, and thus enables surgeons to perform an elective radical surgery, avoiding emergency surgery with stoma and unnecessary surgery for patients with distant metastasis. In the era of enhanced recovery after surgery, the endoscopic metallic stent placement combined with laparoscopic procedures, as a less invasive alternative, is effective and safe.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2017年第6期684-688,共5页
Chinese Journal of Gastrointestinal Surgery
关键词
结直肠肿瘤
肠梗阻
金属支架
腹腔镜手术
一期吻合
Colorectal neoplasms
Intestinal obstruction
Metallic stents
Laparoscopic surgery
Primary anastomosis
