肠道支架置入术在结直肠癌肠梗阻治疗中的应用

发布时间：2018-04-02 07:09

本文选题：支架　切入点：内镜　出处：《浙江大学》2017年硕士论文

【摘要】：目的肠梗阻是结直肠癌患者最常见的急重并发症之一,一旦发生,往往需要外科急诊手术干预,但急诊手术的术后并发症发生率和病死率较高。肠道支架的应用,可以及时解除梗阻,恢复肠道功能,将急诊手术转变为更安全的择期手术。本研究旨在探讨内镜下肠道支架置入术在结直肠癌性肠梗阻治疗中的应用效果,并分析比较支架置入后择期手术与急诊外科手术在左半结直肠癌肠梗阻治疗中的临床疗效差别。方法收集2012年6月至2017年1月间因结直肠癌性肠梗阻于我院行内镜下肠道支架置入术治疗的患者26例,回顾分析其临床疗效及并发症情况。再选取其中支架置入后行择期手术的左半结直肠癌肠梗阻患者14例作为研究组,另外选取同期于我院因左半结直肠癌肠梗阻行急诊外科手术治疗的患者19例作为对照组,比较这两组接受不同治疗方式患者的临床疗效及并发症情况等。结果患者支架置入成功率100%(26/26),临床症状缓解率96.15%(25/26),术后有1例(3.85%)患者出现穿孔,1例(3.85%)患者出现再梗阻,2例(7.69%)患者出现少量便血,所有患者无其他严重并发症发生。研究组的一期手术率(50.00%vs.0 P=0.001)、造瘘率(57.14%vs.100%P=0.003)、腹腔镜手术率(85.71%vs.0 P=0.000)、入 ICU 率(7.14%vs.52.63%,P=0.009)、术中出血量(P=0.002)要优于对照组。而两组患者在术后并发症、首次住院时间及费用等方面没有表现出明显的差异(P0.05)。结论在结直肠癌肠梗阻治疗中,肠道支架置入安全可靠,更加微创,并发症更少,在用于解除梗阻后择期手术治疗或姑息治疗方面都有很大的优势。
[Abstract]:Objective intestinal obstruction is one of the most common acute and severe complications in patients with colorectal cancer.The application of intestinal stent can relieve obstruction in time, restore intestinal function, and transform emergency operation into safer elective operation.The purpose of this study was to investigate the efficacy of endoscopic intestinal stenting in the treatment of colorectal cancer intestinal obstruction, and to compare the clinical effects of selective and emergency surgery after stent implantation in the treatment of left colorectal cancer intestinal obstruction.Methods from June 2012 to January 2017, 26 patients with colorectal cancer intestinal obstruction underwent endoscopic stenting, and their clinical efficacy and complications were analyzed retrospectively.Among them, 14 patients with intestinal obstruction of left colorectal cancer who underwent elective operation after stent implantation were selected as study group, and 19 patients who underwent emergency surgical treatment for intestinal obstruction of left colorectal cancer in our hospital were selected as control group.The clinical efficacy and complications were compared between the two groups.Results the success rate of stent implantation was 100 / 26 / 26, the remission rate of clinical symptoms was 96.1525 / 26 / 26, and one patient with perforation was found to have perforation (1 case with 3. 85%) and 2 cases with recurrent obstruction (2 cases with 7. 69%) had a small amount of blood stool, and no other serious complications occurred in all the patients.In the study group, the rate of primary operation was 50.00vs.0, the rate of fistula was 57.14, the rate of laparoscopy was 85.71 and the rate of laparoscopy was 85.71vs.0P0.000, the rate of ICU was 7.14vs.52.63 and the volume of blood loss during operation was 0.002) was better than that of the control group.However, there was no significant difference in postoperative complications, first hospitalization time and cost between the two groups (P 0.05).Conclusion in the treatment of colorectal cancer intestinal obstruction, intestinal stent implantation is more safe and reliable, less invasive, less complications, and has great advantages in selective surgery or palliative treatment after relieving obstruction.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

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