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首页> 外文期刊>Surgical Endoscopy >Management of obstructive colorectal cancer with endoscopic stenting followed by single-stage surgery: open or laparoscopic resection?
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Management of obstructive colorectal cancer with endoscopic stenting followed by single-stage surgery: open or laparoscopic resection?

机译：内镜支架置入术后单期手术治疗阻塞性大肠癌：开放式还是腹腔镜切除？

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BACKGROUND: About one-third of patients with colorectal carcinoma present with acute colonic obstruction requiring emergency surgery. Current surgical options are intraoperative lavage and resection of the colonic segment involved with primary anastomosis, subtotal colectomy with primary anastomosis, colostomy followed by resection, and resection of the colonic segment involved with end colostomy (Hartmann's procedure) requiring a second operation to reconstruct the colon. These procedures present risks and a poor quality of life. Endoscopic colonic stent insertion can effectively decompress the obstructed colon, allowing bowel preparation and elective resection. METHODS: The authors present their experience managing 31 patients with obstructing colorectal cancer who underwent endoscopic colonic decompression with self-expanding metallic stents. A total of 16 patients were treated with open resection, and 6 underwent a laparoscopic resection. The remaining 9 patients were managed with endoscopic palliation and adjuvant therapy. Of the 31 patients, 17 were treated with postoperative chemotherapy. RESULTS: The mean interval between stenting and surgery was 11 days (range, 1-21 days). There was no intraoperative morbidity. The incidence of postoperative morbidity was 20% for open surgery and 0% for laparoscopic surgery. The mean postoperative hospital stay was 13 days for the open surgery group, and 7 days for the laparoscopic group (p = 0.003). The hospital mortality rate was 3.2%. Follow-up evaluation was completed for 96% of the patients. The minimum follow-up period was 15 months. All the patients in the palliative group died of disease, with a median survival of 3 months. Of the 22 surgically treated patients, 17 (77%) are alive at this writing. CONCLUSION: This initial experience shows that after successful endoscopic stenting of malignant colorectal obstruction, elective surgical resection can be performed safely. The presence of the endoluminal stent does not prevent a laparoscopic approach. Thecombined endoscopic and laparoscopic procedures are a less invasive alternative to the multistage open operations and offer a faster recovery.
机译：背景：大肠癌患者中约有三分之一患有急性结肠梗阻，需要紧急手术。当前的外科手术选择是术中灌洗和切除原发性吻合的结肠段，大肠切除术合并原发性吻合，结肠造口术然后切除，以及切除与结肠造口术相关的结肠段（Hartmann手术），需要第二次手术来重建结肠。这些程序带来风险和生活质量低下。内窥镜结肠支架置入术可以有效地解压阻塞的结肠，从而可以进行肠准备和选择性切除。方法：作者介绍了他们的经验，该方法治疗了31例使用自扩张金属支架进行内镜结肠减压的结直肠癌梗阻患者。共有16例患者接受了开放性切除术，其中6例接受了腹腔镜切除术。其余9例患者接受了内镜下缓解和辅助治疗。在这31例患者中，有17例接受了术后化疗。结果：支架置入与手术之间的平均间隔为11天（范围：1-21天）。没有术中发病率。开腹手术和腹腔镜手术的术后发病率分别为20％和0％。开放手术组的平均术后住院天数为13天，腹腔镜手术组的平均术后住院天数为7天（p = 0.003）。医院死亡率为3.2％。 96％的患者完成了随访评估。最小随访期为15个月。姑息治疗组的所有患者均死于疾病，中位生存期为3个月。在撰写本文的22位接受手术治疗的患者中，有17位（77％）还活着。结论：该初步经验表明，在内镜下成功置入恶性大肠梗阻后，可以安全地进行选择性手术切除。腔内支架的存在不会阻止腹腔镜手术。内窥镜和腹腔镜手术相结合，是多阶段开放手术的侵入性较小的替代方法，并且恢复速度更快。

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