| Objective:To retrospectively study the medium-and short-term effects of two treatment methods in patients with acute intestinal obstruction caused by left colon cancer,to explore the factors affecting the survival of left colon cancer,and to provide theoretical support for clinical treatment of obstructive left colon cancer.Methods:The basic clinical and perioperative data of patients with acute intestinal obstruction caused by left colon cancer in the affiliated Hospital of Inner Mongolia Medical University from January 2015 to March 2020 were collected,and the patients were followed up for late treatment and survival.The patients were divided into stent combined with selective operation group and emergency operation group according to different treatment methods.The baseline data,postoperative complications,postoperative remission and survival of the two groups were compared,and the survival curve was drawn according to the follow-up time and survival status.Finally,the factors that may affect survival were established by COX regression model to predict the factors affecting survival.Explore the factors that may affect survival in the subgroup and then draw a conclusion.Results: 1.A total of 123 patients with obstructive colon cancer were collected,including 64 patients with stents,including 24 patients with palliative treatment,9 patients with stage IV,1patient with right colon obstruction,1 pathologically benign patient,5 patients with loss of follow-up,and finally 24 patients in the stent group,59 patients with emergency operation,8patients with IV stage,15 patients with loss of follow-up,and finally 36 patients in the operation group.2.There was no significant difference in baseline data between the two groups except primary tumor(T)(P > 0.05).The primary tumor(T4)stent group was more than the operation group(33.33% > 8.33%),and the difference was statistically significant(P< 0.05).The incidence of postoperative complications in the stent group was significantly lower than that in the operation group(25.00% < 52.78%),and the difference was statistically significant(P < 0.05).However,there was no difference in the incidence of single complication between the two groups(P > 0.05).3.In the comparison of postoperative remission and survival,the statistical results showed that there was no significant difference in clinical remission,survival and follow-up time between the two groups(P > 0.05).The postoperative radiotherapy and chemotherapy in the stent group was significantly higher than that in the operation group(58.33% > 27.78%),and there was significant difference between the two groups(P < 0.05).In terms of the mode of operation,the minimally invasive rate in the stent group was higher,and the difference was statistically significant(P < 0.05).4.After a 3-year follow-up,the 1-and 3-year survival rates of 60 patients in the life table were 82.00%and 68.00% respectively,and the overall survival rate was 68.30%.The 1-and 3-year survival rates of the stent group were 88.00% and 71.00%,respectively.The 1-and 3-year survival rates of the operation group were 85.00% and 67.00%,respectively.There was no significant difference in survival curve between the two groups(P > 0.05).The survival curve of postoperative radiotherapy and chemotherapy showed that the survival rate of postoperative patients with radiotherapy and chemotherapy was significantly better than that of patients without radiotherapy and chemotherapy,and the difference was statistically significant(P <0.05).5.COX regression model showed that age,signet ring cell carcinoma in pathology,postoperative bleeding and CEA all had significant effects on survival,and the risk of death increased by 3.70% for every 1 year increase in age;the death risk of signet ring cell cancer in colon cancer was 37 times higher than that of ordinary adenocarcinoma;and the risk of death increased by 0.90% for every 1 unit increase in CEA value.6.intraoperative colostomy is an independent factor affecting the survival of the emergency operation group,while the interval between stent and elective operation has no effect on the survival of the stent group.Conclusions: 1.There was no significant difference in 3-year survival rate between left colon cancer acute obstruction stent implantation combined with elective surgery and emergency operation.2.The incidence of postoperative complications of acute obstruction stent implantation combined with elective operation for left colon cancer was significantly lower than that of emergency operation group.3.Stent combined with elective surgery can increase the probability of minimally invasive surgery.4.Age,signet ring cell carcinoma in pathological classification,CEA,postoperative bleeding and intraoperative colostomy are independent factors affecting the survival of left semi-obstructive colon cancer. |
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