摘要
目的通过该院2017-2019年经内镜下置入结肠支架治疗急性肠梗阻的患者进行临床观察及分析,评估内镜下支架置入治疗的疗效及安全性。方法方便收集该院2017年1月-2019年3月因左半结肠癌致急性肠梗阻行经内镜下结肠支架置入术治疗共53例患者临床资料进行分析,并选取同期左半结肠癌并梗阻行急诊手术(入院<72 h)的患者共26例为对照组,对比手术时间、肠道功能恢复时间、一期吻合及入住ICU情况进行对比分析。结果支架组53例技术成功率达88.7%,其中有ERCP经验的医师技术成功率可高达95.5%,临床成功率达100.0%,并发症发生率低穿孔(5.7%)、出血(11.3%)、移位(1.9%)、再梗阻(1.9%);作为手术过度阶段,支架置入后手术较急诊手术组在手术时间(144.5±45.5) min vs (180.4±30.8) min(t=3.590,P<0.05)、术后肛门排气/排便天数(1.0±0.5)d vs(3.5±1.0)d,差异有统计学意义(t=11.600,P<0.05),在一期吻合率支架组(15/29)较急诊手术组(7/26),差异有统计学意义(χ~2=4.470,P<0.05),术后入住ICU发生数(1/29)vs(5/26),差异有统计学意义(χ~2=3.500,P<0.05),但例数明显小于急诊手术组。结论内镜下放置金属支架来缓解恶性结肠梗阻是一种安全且有效的技术,对于可以手术的患者,它提供了一种有用的选择,更达可能避免结肠造瘘,提高一期吻合机会。
Objective To evaluate the clinical outcomes and safety of self-expanding metal endoscopic stent(SEMS) implantation in patients with acute intestinal obstruction from 2017 to 2019. Methods Convenient select Clinical data of 53 patients with acute intestinal obstruction caused by left-sided colon cancer from January 2017 to March 2019 were included in this study. A total of 26 patients with left-sided colon cancer complicated with obstruction who received emergency operation(admitted to hospital<72 hours) were selected as the control group. Operation time, recovery time of intestinal function, one-stage anastomosis and ICU admission were compared and analyzed. Results The technical success rate of the 53 cases in the stent group was 88.7%, among which the technical success rate of the physicians with ERCP experience was as high as 95.5%, and the clinical success rate was 100.0%, with low complication rate of perforation(5.7%), bleeding(11.3%), displacement(1.9%), and re-obstruction(1.9%). As a transitional stage of surgery, there was a statistically significant difference in operative time(144.5 ±45.5)min vs(180.4 ±30.8)min,(t =3.590,P <0.05) and postoperative anal exhaust/defecation days(1.0±0.5)d vs(3.5±1.0)d(t=11.600, P<0.05) between the stent group and the emergency surgery group after stent implantation, and a statistically significant difference between the stent group and the emergency surgery group(15/29) vs(7/26)(χ~2=4.470, P<0.05). The number of postoperative ICU admissions(1/29) vs(5/26) had statistical significance difference(χ~2=3.500, P <0.05), but the number of cases was significantly lower than that of the emergency surgery group. Conclusion SEMS is a safe and effective technique for alleviating malignant colon obstruction. It provides a useful option for patients that are suitable for receiving the operation, and may avoid colostomy and improve the chance of one-stage anastomosis.
作者
陆翠钦
龚清全
颜丽君
LU Cui-qin;GONG Qing-quan;YAN Li-jun(Department of Gastroenterology,Mindong Hospital of Ningde City,Fu'an,Fujian Province,355000 China)
出处
《中外医疗》
2020年第6期48-51,共4页
China & Foreign Medical Treatment
关键词
结肠支架
左半结肠癌
肠梗阻
Colon stent
Left-sided colon cancer
Intestinal obstruction
