应用经肛肠梗阻减压导管治疗结直肠癌伴梗阻的疗效分析

发布时间：2018-06-28 17:01

  本文选题：结直肠肿瘤 + 肠梗阻　； 参考：《南昌大学》2016年硕士论文

【摘要】：目的:探讨应用经肛肠梗阻减压导管将结直肠癌伴急性梗阻患者由急诊手术转化为限期手术的疗效分析。方法:入选2011年5月1日至2015年5月30日我院胃肠外科收治的结直肠癌伴急性梗阻患者117例,收集所有入组患者的基本资料,按是否应用经肛肠梗阻减压导管将急诊手术转化为限期手术分为急诊手术组和限期手术组。收集两组患者术前及术后的血液生化指标,统计两组患者的手术方式、术后并发症及术后病理结果,随访患者生存时间。计量资料以均数±标准差(`x±SD)表示,正态分布资料采用两样本t检验比较组间差异,计数资料采用χ2检验比较组间差异,运用Kaplan-Meier法绘制生存曲线,生存率的比较和对影响预后的相关因素单因素分析采用Log-rank检验,多因素分析采用Cox比例风险回归模型。结果:1、急诊手术组患者术前ASA评分高于限期手术组,而术前血浆白蛋白水平较限期手术组为低(P0.05),肿瘤一期切除吻合、腹腔镜手术的应用方面显著低于限期手术组(P0.01)。2、急诊手术组患者发生术后发热、菌血症、腹腔感染、下肢水肿、低钠血症、低钾血症、低蛋白血症、吻合口瘘、住院期间死亡率高于限期手术组(P0.05),而恶心、呕吐,肺部感染,术后肠梗阻、手术切口感染无统计学差异(P0.05)。3、限期手术组在淋巴结清扫数目上(14.8±5.7枚)明显高于急诊手术组(10.6±8.8枚)(P0.01)。4、单因素分析结果显示:术前CEA、CA19-9升高,ASA评分≥3分,TNM分期≥III期,肿瘤病理类型为低分化腺癌、粘液腺癌,淋巴结清扫数目13枚,肿瘤周围神经浸润阳性,急诊手术均为影响患者生存率和无瘤生存率的危险因素(P0.05)。多因素分析结果显示:淋巴结清扫数目13枚,肿瘤周围神经浸润阳性为影响患者生存预后和无瘤生存的独立危险因素(P0.05)。肿瘤最大径≥5cm,急诊手术为影响患者无瘤生存预后的独立危险因素(P0.05)。结论:应用经肛肠梗阻减压导管可以将结直肠癌伴急性梗阻的患者有效的从急诊手术治疗转化为限期手术治疗,从而获得良好的术前准备,降低患者的术后并发症发生率,使患者获得生存收益,是治疗结直肠癌梗阻的有效措施。
[Abstract]:Objective: to investigate the effect of transanal ileus decompression catheter in transforming colorectal cancer with acute obstruction from emergency operation to limited operation. Methods: 117 cases of colorectal cancer with acute obstruction were selected from May 1, 2011 to May 30, 2015 in our hospital. According to the use of transanal obstruction decompression catheter, the emergency operation was divided into emergency operation group and limited operation group. The blood biochemical indexes before and after operation were collected, the operation mode, postoperative complications and pathological results of the two groups were analyzed, and the survival time of the patients were followed up. The measurement data were expressed as mean 卤standard deviation (`x 卤SD). The normal distribution data were compared by two samples t test, the counting data were compared by 蠂 2 test, and the survival curve was drawn by Kaplan-Meier method. The survival rate was compared and univariate analysis of prognostic factors was performed by Log-rank test and Cox proportional risk regression model was used for multivariate analysis. Results the preoperative ASA score of emergency operation group was higher than that of limited operation group, but the preoperative plasma albumin level was lower than that of limited operation group (P0.05). The tumor was resected and anastomosed in one stage. The application of laparoscopic surgery was significantly lower than that of the limited period operation group (P0.01). The patients in the emergency operation group developed postoperative fever, bacteremia, abdominal infection, edema of lower extremity, hyponatremia, hypokalemia, hypoproteinemia, anastomotic leakage, The mortality rate during hospitalization was higher than that in the limited period operation group (P0.05), but nausea, vomiting, pulmonary infection, postoperative intestinal obstruction, There was no significant difference in incisional infection (P0.05). The number of lymph node dissection in the limited operation group (14.8 卤5.7) was significantly higher than that in the emergency operation group (10.6 卤8.8) (P0.01) .The results of univariate analysis showed that the preoperative CEA CA19-9 increased ASA score 鈮，

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