本文選題：急性結(jié)直腸梗阻 + 結(jié)直腸SEMS�。� 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：介紹:結(jié)腸癌(CRC)在中國所有腫瘤的發(fā)生率和癌源性死亡癌癥種類中均排名第5。CRC在出現(xiàn)急性結(jié)腸梗阻(ACO)之前往往容易被忽視,這種情況占7%-29%。急性左半結(jié)腸癌惡性梗阻(ALMCO)是危及生命的急癥,對(duì)其處理上存在爭議。急診ALMCO手術(shù)與高致病率,高死亡率和結(jié)腸造瘺相關(guān),內(nèi)鏡下大腸自膨式金屬內(nèi)支架(SEMS)于90年代問世,提供了一種采用微創(chuàng)和非手術(shù)治療的方式來解除除道阻塞的方法。本文目的是比較采用結(jié)腸支架后擇期開腹手術(shù)和直接急診行哈特曼手術(shù)(HARTMANN’S手術(shù))或結(jié)腸灌洗后行結(jié)腸切除并一期吻合手術(shù)兩者之間臨床效果和成本效益的差別。方法:采用回顧性的研究的方法,收集從2010年1月到2016年12月連醫(yī)科大學(xué)附屬第二醫(yī)院所有結(jié)腸癌合并腸梗阻的確診病例,經(jīng)納入和排除標(biāo)準(zhǔn)篩選后,將患者依據(jù)治療方法分為3組:SEMS支架組,ICI結(jié)腸灌洗組,HP哈特曼術(shù)組。在置入支架后擇期行開腹手術(shù)患者被分為SEMS支架組,而HP組和ICI組的患者為急診行哈特曼手術(shù)和結(jié)腸灌洗后行結(jié)腸切除并一期吻合手術(shù)的患者。結(jié)果:82人(36.12%)從227名左半結(jié)腸癌梗阻患者中入選。SEMS組、ICI組和HP組分別有10、23和49例。男性占大多數(shù),為64.6%,女性為35.4%,中位數(shù)年齡69.5歲(60.75~77.25)。乙狀結(jié)腸病變例最常見占63.4%,98.8%的病變是腺癌。結(jié)腸支架置入成功率為100%和90%,只有一例病例患者置入結(jié)腸支架導(dǎo)致腸穿孔。結(jié)果顯示使用SEMS支架的患者組與其余兩組相比手術(shù)時(shí)間更短,一期吻合成功率更高,造瘺情況出現(xiàn)更少(P0.05).而HP組明顯(P0.05)比其他2組有更快的排氣時(shí)間,最早過渡至經(jīng)口進(jìn)食,治療成本最低。ICI組有兩名患者出現(xiàn)吻合口瘺,HP組有兩名患者最終死亡,但術(shù)后發(fā)病率和死亡率均無統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:1、SEMS支架在左半結(jié)腸癌急性梗阻患者術(shù)前減壓治療中安全微創(chuàng)有效。2、SEMS置入后擇期手術(shù)治療優(yōu)于急診手術(shù),術(shù)后發(fā)病率和死亡率均可接受。
[Abstract]:Introduction: colorectal cancer (CRC) ranks fifth in all cancer incidence and cancer death types in China before acute colonic obstruction (ACO), which accounts for 7- 29%. Acute left colon cancer malignant obstruction (ALMCO) is a life-threatening emergency and its management is controversial. Emergency ALMCO surgery is associated with high morbidity, high mortality and colostomy. Endoscopic self-expandable metallic stent (SEMS) was introduced in the 1990s, providing a minimally invasive and non-surgical treatment for removing obstruction of the tract. The purpose of this study was to compare the clinical efficacy and cost-effectiveness between elective open surgery with colon stent and Hartmann's operation (Hartmann's operation) or colectomy after colonic lavage with one-stage anastomosis. Methods: from January 2010 to December 2016, all confirmed cases of colon cancer complicated with intestinal obstruction were collected from January 2010 to December 2016. The patients were divided into 3 groups according to the treatment method: 1: SEMS stent group, ICI colon lavage group and HP Hartmann group. Patients undergoing elective open surgery after stent placement were divided into SEMS stent group, HP group and ICI group. Patients in HP group and ICI group underwent emergency Hartmann operation, colon lavage and colectomy and primary anastomosis. Results among 227 patients with obstruction of left colon cancer, 1023 were in the ICI group and 49 in the HP group in the SEMS group. The median age was 69.5 years (60.75 / 77.25). Adenocarcinoma is the most common disease in sigmoid colon (63.4%). The success rate of colon stent implantation was 100% and 90% respectively. The results showed that the patients with SEMS stents had shorter operation time higher success rate of primary anastomosis and less fistula than the other two groups (P0.05). The HP group (P0.05) had a faster time of exhaust than the other two groups, the earliest transition to oral feeding, the lowest cost of treatment .ICI group has two patients with anastomotic fistula and HP group, two patients eventually died, However, there was no significant difference in postoperative morbidity and mortality (P0.05). Conclusion it is safe and effective to treat the patients with acute obstruction of left colon cancer by using 1% SEMS stent before operation. The selective operation after SEMS implantation is superior to that of emergency operation. The morbidity and mortality are acceptable after operation.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.35

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本文編號(hào)：2070893