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目的:探讨内镜联合X线置放金属支架后择期手术与急诊外科手术相比,两者治疗可切除性结直肠恶性梗阻的临床价值及安全性。方法:回顾性分析2001年5月~2012年10月本院94例结直肠恶性梗阻患者的临床资料。其中30例经内镜联合X线临时置入金属支架,择期行手术治疗;64例行急诊手术治疗。比较支架组与急诊手术组的一期切除吻合率、手术时间、术后通气时间、住院时间、并发症发生率及住院期间病死率等指标并观察支架置入操作成功率、临床缓解率、并发症发生率及置入后接受剖腹手术和腹腔镜手术情况。结果:①支架组一期切除吻合率明显高于急诊手术组(96.67%vs 53.13%,P<0.001)。支架组术后并发症明显低于急诊手术组(6.67%vs 25.00%,P<0.05)。支架组住院期间病死率与急诊手术组相比,无统计学差异(P>0.05)。支架组手术时间、术后通气时间分别为(156.13±49.79)min,(3.60±1.40)d,明显低于急诊手术组。支架组住院时间与急诊手术组相比,无统计学差异(P>0.05);②支架组中30例放置金属支架,操作成功率100%(30/30),临床缓解率96.67%(29/30),并发症发生率6.67%(2/30),支架置入后平均(8.9±1.0)d行择期手术。支架组接受腹腔镜手术的患者明显多于急诊手术组(P<0.01)。支架组中剖腹手术的手术时间短于微创腹腔镜术(P<0.05),剖腹术后并发症明显低于微创腹腔镜术(P<0.05),但剖腹术患者的住院时间明显长于腹腔镜术的患者(P<0.05)。结论:内镜联合X线置放金属支架可迅速、有效缓解结直肠恶性梗阻症状。经支架置入后择期手术与急诊手术相比安全性高,且增加一期切除吻合率,并减少并发症,可作为缓解结直肠恶性梗阻的一项有效治疗方法。剖腹手术仍是结直肠恶性梗阻支架置入后的主要手术方式。通过支架置入,可使部分患者获得微创手术机会。
OBJECTIVE: To investigate the clinical value and safety of the two methods in treating resectable colorectal malignant obstruction after elective endoscopic surgery combined with X-ray placement of elective stent and emergency surgery. Methods: The clinical data of 94 patients with malignant colorectal obstruction in our hospital from May 2001 to October 2012 were retrospectively analyzed. Among them, 30 cases were temporarily placed in metal stents by endoscopic combined with X-ray and were treated by surgery. Elective surgery was performed in 64 cases. One-stage resection and anastomosis rate, operation time, postoperative ventilation time, hospitalization time, complication rate and hospital mortality were compared between the stent group and the emergency operation group. The success rate, clinical remission rate, The incidence of disease and after receiving laparotomy and laparoscopic surgery. Results: ① The primary anastomosis rate of stent group was significantly higher than that of emergency operation group (96.67% vs 53.13%, P <0.001). The postoperative complications of the stent group were significantly lower than those of the emergency operation group (6.67% vs 25.00%, P <0.05). There was no significant difference in mortality rate between the stent group and the emergency surgery group during hospitalization (P> 0.05). The operation time and postoperative ventilation time in the stent group were (156.13 ± 49.79) min and (3.60 ± 1.40) d respectively, which were significantly lower than those in the emergency operation group. There was no significant difference in the hospitalization duration between the stent group and the emergency operation group (P> 0.05). ② In the stent group, 30 cases were placed with metal stent, the operation success rate was 100% (30/30), the clinical remission rate was 96.67% 30). The complication rate was 6.67% (2/30). The average time of stent implantation was (8.9 ± 1.0) d. The number of patients receiving stent laparoscopic surgery was significantly higher than that of emergency surgery group (P <0.01). The operative time of laparotomy in the stent group was shorter than that of minimally invasive laparoscopic surgery (P <0.05). The complications after laparotomy were significantly lower than those of minimally invasive laparoscopic surgery (P <0.05), but the hospitalization time of laparotomy patients was significantly longer than that of abdominal cavity Patients underwent surgery (P <0.05). Conclusion: Endoscopic combined with X-ray placement of metal stent can quickly and effectively alleviate the symptoms of colorectal malignant obstruction. Elective stent implantation after elective surgery and emergency surgery compared to high safety, and increase the number of resection and anastomosis, and reduce complications, can be used as an effective treatment of colorectal malignant obstruction. Caesarean section remains the primary surgical modality for colorectal malignant obstruction after implantation. Through the stent implantation, can make some patients access to minimally invasive surgery.