急性左半结肠梗阻支架治疗后开腹手术可行性、安全性及住院费用的评估

发布时间：2018-06-26 17:53

本文选题：急性结直肠梗阻 + 结直肠SEMS　；参考：《大连医科大学》2017年硕士论文

【摘要】：介绍:结肠癌(CRC)在中国所有肿瘤的发生率和癌源性死亡癌症种类中均排名第5。CRC在出现急性结肠梗阻(ACO)之前往往容易被忽视,这种情况占7%-29%。急性左半结肠癌恶性梗阻(ALMCO)是危及生命的急症,对其处理上存在争议。急诊ALMCO手术与高致病率,高死亡率和结肠造瘘相关,内镜下大肠自膨式金属内支架(SEMS)于90年代问世,提供了一种采用微创和非手术治疗的方式来解除除道阻塞的方法。本文目的是比较采用结肠支架后择期开腹手术和直接急诊行哈特曼手术(HARTMANN’S手术)或结肠灌洗后行结肠切除并一期吻合手术两者之间临床效果和成本效益的差别。方法:采用回顾性的研究的方法,收集从2010年1月到2016年12月连医科大学附属第二医院所有结肠癌合并肠梗阻的确诊病例,经纳入和排除标准筛选后,将患者依据治疗方法分为3组:SEMS支架组,ICI结肠灌洗组,HP哈特曼术组。在置入支架后择期行开腹手术患者被分为SEMS支架组,而HP组和ICI组的患者为急诊行哈特曼手术和结肠灌洗后行结肠切除并一期吻合手术的患者。结果:82人(36.12%)从227名左半结肠癌梗阻患者中入选。SEMS组、ICI组和HP组分别有10、23和49例。男性占大多数,为64.6%,女性为35.4%,中位数年龄69.5岁(60.75~77.25)。乙状结肠病变例最常见占63.4%,98.8%的病变是腺癌。结肠支架置入成功率为100%和90%,只有一例病例患者置入结肠支架导致肠穿孔。结果显示使用SEMS支架的患者组与其余两组相比手术时间更短,一期吻合成功率更高,造瘘情况出现更少(P0.05).而HP组明显(P0.05)比其他2组有更快的排气时间,最早过渡至经口进食,治疗成本最低。ICI组有两名患者出现吻合口瘘,HP组有两名患者最终死亡,但术后发病率和死亡率均无统计学差异(P0.05)。结论:1、SEMS支架在左半结肠癌急性梗阻患者术前减压治疗中安全微创有效。2、SEMS置入后择期手术治疗优于急诊手术,术后发病率和死亡率均可接受。
[Abstract]:Introduction: colorectal cancer (CRC) ranks fifth in all cancer incidence and cancer death types in China before acute colonic obstruction (ACO), which accounts for 7- 29%. Acute left colon cancer malignant obstruction (ALMCO) is a life-threatening emergency and its management is controversial. Emergency ALMCO surgery is associated with high morbidity, high mortality and colostomy. Endoscopic self-expandable metallic stent (SEMS) was introduced in the 1990s, providing a minimally invasive and non-surgical treatment for removing obstruction of the tract. The purpose of this study was to compare the clinical efficacy and cost-effectiveness between elective open surgery with colon stent and Hartmann's operation (Hartmann's operation) or colectomy after colonic lavage with one-stage anastomosis. Methods: from January 2010 to December 2016, all confirmed cases of colon cancer complicated with intestinal obstruction were collected from January 2010 to December 2016. The patients were divided into 3 groups according to the treatment method: 1: SEMS stent group, ICI colon lavage group and HP Hartmann group. Patients undergoing elective open surgery after stent placement were divided into SEMS stent group, HP group and ICI group. Patients in HP group and ICI group underwent emergency Hartmann operation, colon lavage and colectomy and primary anastomosis. Results among 227 patients with obstruction of left colon cancer, 1023 were in the ICI group and 49 in the HP group in the SEMS group. The median age was 69.5 years (60.75 / 77.25). Adenocarcinoma is the most common disease in sigmoid colon (63.4%). The success rate of colon stent implantation was 100% and 90% respectively. The results showed that the patients with SEMS stents had shorter operation time higher success rate of primary anastomosis and less fistula than the other two groups (P0.05). The HP group (P0.05) had a faster time of exhaust than the other two groups, the earliest transition to oral feeding, the lowest cost of treatment .ICI group has two patients with anastomotic fistula and HP group, two patients eventually died, However, there was no significant difference in postoperative morbidity and mortality (P0.05). Conclusion it is safe and effective to treat the patients with acute obstruction of left colon cancer by using 1% SEMS stent before operation. The selective operation after SEMS implantation is superior to that of emergency operation. The morbidity and mortality are acceptable after operation.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.35

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