| Objective:To investigate the clinical effect of intestinal stent as a preoperative bridge in acute left obstructive colorectal cancer and its influence on the therapeutic effect.Methods:The clinical data of patients with acute intestinal obstruction caused by left colorectal cancer who were treated in the Affiliated Hospital of Gui Lin Medical University from January 2018 to June 2021 were collected and divided into emergency surgery and stent implantation combined with limited surgery group according to different treatment methods.The relevant clinical data were analyzed and the perioperative outcomes and survival results were compared between the two groups.Results:A total of 111 patients were included in the study,including 64patients in the emergency surgery group(emergency group),43 patients in the stent implantation combined with limited surgery group(stent group),4 patients with stent implantation technique and clinical failure,and patients with failure were not included in the final comparative study.The technical success rate of stented patients was 95.7%(45/47),and the clinical success rate was 95.6%(43/45).There were no statistically significant differences between the two groups in baseline data such as age、gender、body mass index、tumor length、age-adjusted Charlson comorbidity index、American Society of Anesthesiologists grade、tumor stage、tumor differentiation、length of obstruction and follow-up time(P>0.05).In terms of surgical approach,the laparoscopic surgery rate was significantly higher in the stent group than in the emergency group(74.4%,32/43 vs 26.6%,17/64;(?)~2=23.729;P<0.001).The primary resection and anastomosis rate was 69.8%(30/43)in the stent group,and 42.2%(27/64)in the emergency group,and the difference had statistical significance((?)~2=7.859;P=0.005);the prophylactic stoma rate was 44.2%(19/43)in the stent group,and 76.6%(49/64)in the emergency group,the difference had statistical significance((?)~2=13.011;P=0.001);the operation time was shorter in the stent group(173.65±47.97 min vs 217.59±64.26 min,t=3.823;P<0.001),the postoperative ICU monitoring rate was lower(18.6%,8/43 vs 43.8%,28/64;(?)~2=7.284;P=0.007),and the postoperative hospital stay was shorter(8 d vs 9 d,Z=2.293;P=0.022).In terms of local recurrence rate at the deadline of follow-up,9.8%(4/41)and 9.8%(6/61)in the two groups respectively,without significant statistical difference((?)~2=0;P=1.000);the distant metastasis rate was 19.5%(8/41)in the stent group,26.2%(16/61)in the emergency group,without significant statistical difference((?)~2=0.615,P=0.433).The median survival time was 29 months in the stent group and was 36months in the emergency group.There was no significant difference in the overall survival rate between the two groups(P=0.340).Conclusions:Self-expandable metallic stent as a bridge to limited surgery has advantages in the short-term effect,which can significantly improve the primary anastomosis rate,shorten the postoperative hospital stay,reduce the intraoperative ostomy rate and improve the quality of life of patients.At the same time,it is seen that stent implantation does not affect the survival outcome of patients from the existing data. |
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