摘要
目的评估可扩张金属支架(SEMS)联合新辅助化疗对完全梗阻性左半结肠癌患者围手术期并发症的影响,并探讨支架相关并发症的管理。方法本研究回顾性分析了2012年1月至2023年5月在首都医科大学附属北京朝阳医院收治的93例完全梗阻性左半结肠癌患者的临床资料。根据治疗方案,将患者分为支架组(44例)和支架-新辅助组(49例)。主要观察SEMS置入后支架相关并发症发生率(穿孔、再次梗阻、移位、梗阻不缓解)及支架相关并发症的管理。结果所有患者均获随访。支架-新辅助组患者的术后早期并发症发生率显著低于支架组(14.3%vs.38.6%,P=0.007)。支架-新辅助组的腹腔镜手术比例(85.7%vs.61.4%,P=0.007)、术后住院时间(10.88±5.60天vs.13.30±5.82天,P=0.044)、回肠造口率(10.6%vs.28.6%,P=0.037)均优于支架组。支架相关并发症的发生率在两组之间差异无统计学意义(14.3%vs.13.6%,P=0.928),其中穿孔(6.1%vs.6.8%,P=1.000)、再次梗阻(6.1%vs.4.5%,P=1.000)、移位(2.0%vs.0.0%,P=1.000)、梗阻不缓解发生率(0.0%vs.2.3%,P=0.473)差异均无统计学意义。穿孔共发生6例(6.5%)。支架-新辅助组3例(6.1%),分别发生于SEMS置入后7天、8天、188天;支架组共发生3例(6.8%),分别发生于SEMS置入后4天、5天、13天。其中再次梗阻发生5例(5.4%)。支架-新辅助组3例(6.1%),分别发生于SEMS置入后69天、75天、76天;支架组2例(4.5%),分别发生于SEMS置入后74天、139天。移位发生1例(1.1%),为支架-新辅助组的患者(2.0%),发生于SEMS置入后93天。梗阻不缓解发生1例(1.1%),为支架组的患者(2.3%),于SEMS置入后5天确认。结论可扩张金属支架联合新辅助化疗可改善完全梗阻性左半结肠癌患者的手术效果,并不额外增加支架相关并发症风险。
Objective To evaluate the impact of self-expanding metallic stents(SEMS)combined with neoadjuvant chemotherapy on postoperative complications in patients with completely obstructive leftsided colon cancer,and to explore the management of stent-related complications.Methods This study retrospectively analyzed the clinical data of 93 patients with completely obstructive left-sided colon cancer who were treated at Beijing Chaoyang Hospital,Capital Medical University,from January 2012 to May 2023.According to the treatment plan,patients were divided into the stent group(44 cases)and the stentneoadjuvant group(49 cases).The main observations were the postoperative stent-related complications rate(perforation,reobstruction,migration,and unresolved obstruction)and the management of stent-related complications.Results All patients were followed up.The incidence of early postoperative complications in the stent-neoadjuvant group was significantly lower than in the stent group(14.3%vs.38.6%,P=0.007).The stent-neoadjuvant group had better outcomes in terms of the proportion of laparoscopic surgery(85.7%vs.61.4%,P=0.007),postoperative hospital stay(10.88±5.60 days vs.13.30±5.82 days,P=0.044),and ileostomy rate(10.6%vs.28.6%,P=0.037).There was no significant difference in the incidence of stentrelated complications between the two groups(14.3%vs.13.6%,P=0.928),including perforation(6.1%vs.6.8%,P=1.000),reobstruction(6.1%vs.4.5%,P=1.000),migration(2.0%vs.0.0%,P=1.000),and unresolved obstruction(0.0%vs.2.3%,P=0.473),respectively.A total of six cases(6.5%)of stent-related perforation occurred.Three cases(6.1%)in the stent-neoadjuvant group occurred 7,8,and 13 days after stent placement,respectively.Three cases(6.8%)in the stent group occurred 4,5,and 18 days after stent placement.Five cases(5.4%)of reobstruction were recorded.Three cases(6.1%)in the stent-neoadjuvant group occurred 69,75 and 76 days after stent placement,while two cases(4.5%)in the stent group occurred 74,and 139 days after stent placement.One case(1.1%)of migration occurred in the stent-neoadjuvant group(2.0%),ninety-three days after surgery.One case(1.1%)of unresolved obstruction occurred in the stent group(2.3%)5 days after surgery.Conclusion Self-expanding metallic stents combined with neoadjuvant chemotherapy can improve surgical outcomes in patients with completely obstructive left-sided colon cancer without increasing the risk of stent-related complications.
作者
石阳
于剑锋
曹可
翟志伟
叶春祥
王振军
韩加刚
Yang Shi;Jianfeng Yu;Ke Cao;Zhiwei Zhai;Chunxiang Ye;Zhenjun Wang;Jiagang Han(Department of General Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Gastroenterology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中华结直肠疾病电子杂志》
2024年第6期464-471,共8页
Chinese Journal of Colorectal Diseases(Electronic Edition)
基金
国家自然科学基金面上项目(No.82070685)
北京朝阳医院多学科临床创新团队项目(No.CYDXK202206)
北京市卫生健康科技成果和适宜技术推广项目(No.BHTPP2024063)。
关键词
结肠肿瘤
可扩张金属支架
新辅助化疗
完全梗阻性左半结肠癌
并发症
Colonic neoplasms
Self-expanding metallic stents
Neoadjuvant chemotherapy
Completely obstructive left-sided colon cancer
Complications
