老年患者应用自膨式金属支架作为结肠癌急性恶性肠梗阻择期手术的临时处理手段的短期评价

doi:10.3969/j.issn.1009-976X.2020.04.003

摘要/Abstract

摘要： 目的评估自膨式金属支架（SEMS）在恶性肠梗阻患者应用价值和分析。方法选择2014年至2017年作者收治的结肠癌伴急性肠梗阻患者的临床资料。包括接受SEMS处理23例（SEMS组）,未使用SEMS的急诊手术患者31例（no-SEMS组）,所有患者获得根治性切除。结果所有患者均获得手术后30天的随访。SEMS组16例采用腔镜下结肠癌根治手术,7例实施开放手术;no-SEMS组均为开放手术。SEMS组术后恢复总体较no-SEMS组良好,如较短的肠功能恢复时间、较短的肠外营养时间、较短的住院时间和较少的术后并发症总数（均P<0.05）。但SEMS组术前发生1例肠穿孔、2例SEMS移位需要紧急处理。结论针对结肠癌导致的恶性肠梗阻,SEMS内镜结肠支架置入术作为择期手术的桥梁,具有良好的短期效果,但是应该尽量避免SEMS操作并发症。

关键词: 结肠癌, 自膨式金属支架, 急性恶性肠梗阻, 结肠癌根治术

Abstract: Objective To evaluate the application value and analysis of self-expanding metal stent （SEMS） in patients with malignant intestinal obstruction. Methods The data of colon cancer patients with acute intestinal obstruction admitted by the author from 2014 to 2017 were selected. Twenty three patients （SEMS group） received SEMS treatment, and 31 patients （no-SEMS group） received emergency surgery without SEMS. All patients underwent radical resection. Results All patients were followed up for 30 days after operation. In the SEMS group, 16 cases were treated with laparoscopic radical surgery, and 7 cases were treated with open surgery. All patients in no-SEMS group underwent open surgery. The postoperative recovery of SEMS group was better than that of no-SEMS group, such as shorter bowel function time, shorter parenteral nutrition time, shorter hospital stay and total postoperative complications. But in the SEMS group, one case of intestinal perforation and two cases of SEMS displacement needed emergency treatment. Conclusion For malignant intestinal obstruction caused by colon cancer, SEMS as a bridge for elective surgery has good short-term effect, but we should try to avoid complications of SEMS operation.

Key words: acute malignant colonic obstruction, radical resection of colon cancer, self-expandable metallic stent, colon cancer

中图分类号:

R735.3+5

庄志浩, 欧阳秋伟, 陶世明, 霍景山, 吴岷翰, 韩新峰, 贺友. 老年患者应用自膨式金属支架作为结肠癌急性恶性肠梗阻择期手术的临时处理手段的短期评价[J]. 岭南现代临床外科, 2020, 20(04): 421-424.

ZHUANG Zhi-hao, OUYANG Qiu-wei, TAO Shi-ming, HUO Jing-shan, WU Min-han, HAN Xin-feng, HE You. Short-term results of self-expandable metallic stent as a temporary approach to elective operation for acute malignant colonic obstruction in elderly patients[J]. Lingnan Modern Clinics in Surgery, 2020, 20(04): 421-424.

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