發(fā)布時間：2018-06-28 17:01

  本文選題：結(jié)直腸腫瘤 + 腸梗阻　； 參考：《南昌大學(xué)》2016年碩士論文

【摘要】：目的:探討應(yīng)用經(jīng)肛腸梗阻減壓導(dǎo)管將結(jié)直腸癌伴急性梗阻患者由急診手術(shù)轉(zhuǎn)化為限期手術(shù)的療效分析。方法:入選2011年5月1日至2015年5月30日我院胃腸外科收治的結(jié)直腸癌伴急性梗阻患者117例,收集所有入組患者的基本資料,按是否應(yīng)用經(jīng)肛腸梗阻減壓導(dǎo)管將急診手術(shù)轉(zhuǎn)化為限期手術(shù)分為急診手術(shù)組和限期手術(shù)組。收集兩組患者術(shù)前及術(shù)后的血液生化指標,統(tǒng)計兩組患者的手術(shù)方式、術(shù)后并發(fā)癥及術(shù)后病理結(jié)果,隨訪患者生存時間。計量資料以均數(shù)±標準差(`x±SD)表示,正態(tài)分布資料采用兩樣本t檢驗比較組間差異,計數(shù)資料采用χ2檢驗比較組間差異,運用Kaplan-Meier法繪制生存曲線,生存率的比較和對影響預(yù)后的相關(guān)因素單因素分析采用Log-rank檢驗,多因素分析采用Cox比例風(fēng)險回歸模型。結(jié)果:1、急診手術(shù)組患者術(shù)前ASA評分高于限期手術(shù)組,而術(shù)前血漿白蛋白水平較限期手術(shù)組為低(P0.05),腫瘤一期切除吻合、腹腔鏡手術(shù)的應(yīng)用方面顯著低于限期手術(shù)組(P0.01)。2、急診手術(shù)組患者發(fā)生術(shù)后發(fā)熱、菌血癥、腹腔感染、下肢水腫、低鈉血癥、低鉀血癥、低蛋白血癥、吻合口瘺、住院期間死亡率高于限期手術(shù)組(P0.05),而惡心、嘔吐,肺部感染,術(shù)后腸梗阻、手術(shù)切口感染無統(tǒng)計學(xué)差異(P0.05)。3、限期手術(shù)組在淋巴結(jié)清掃數(shù)目上(14.8±5.7枚)明顯高于急診手術(shù)組(10.6±8.8枚)(P0.01)。4、單因素分析結(jié)果顯示:術(shù)前CEA、CA19-9升高,ASA評分≥3分,TNM分期≥III期,腫瘤病理類型為低分化腺癌、粘液腺癌,淋巴結(jié)清掃數(shù)目13枚,腫瘤周圍神經(jīng)浸潤陽性,急診手術(shù)均為影響患者生存率和無瘤生存率的危險因素(P0.05)。多因素分析結(jié)果顯示:淋巴結(jié)清掃數(shù)目13枚,腫瘤周圍神經(jīng)浸潤陽性為影響患者生存預(yù)后和無瘤生存的獨立危險因素(P0.05)。腫瘤最大徑≥5cm,急診手術(shù)為影響患者無瘤生存預(yù)后的獨立危險因素(P0.05)。結(jié)論:應(yīng)用經(jīng)肛腸梗阻減壓導(dǎo)管可以將結(jié)直腸癌伴急性梗阻的患者有效的從急診手術(shù)治療轉(zhuǎn)化為限期手術(shù)治療,從而獲得良好的術(shù)前準備,降低患者的術(shù)后并發(fā)癥發(fā)生率,使患者獲得生存收益,是治療結(jié)直腸癌梗阻的有效措施。
[Abstract]:Objective: to investigate the effect of transanal ileus decompression catheter in transforming colorectal cancer with acute obstruction from emergency operation to limited operation. Methods: 117 cases of colorectal cancer with acute obstruction were selected from May 1, 2011 to May 30, 2015 in our hospital. According to the use of transanal obstruction decompression catheter, the emergency operation was divided into emergency operation group and limited operation group. The blood biochemical indexes before and after operation were collected, the operation mode, postoperative complications and pathological results of the two groups were analyzed, and the survival time of the patients were followed up. The measurement data were expressed as mean 鹵standard deviation (`x 鹵SD). The normal distribution data were compared by two samples t test, the counting data were compared by 蠂 2 test, and the survival curve was drawn by Kaplan-Meier method. The survival rate was compared and univariate analysis of prognostic factors was performed by Log-rank test and Cox proportional risk regression model was used for multivariate analysis. Results the preoperative ASA score of emergency operation group was higher than that of limited operation group, but the preoperative plasma albumin level was lower than that of limited operation group (P0.05). The tumor was resected and anastomosed in one stage. The application of laparoscopic surgery was significantly lower than that of the limited period operation group (P0.01). The patients in the emergency operation group developed postoperative fever, bacteremia, abdominal infection, edema of lower extremity, hyponatremia, hypokalemia, hypoproteinemia, anastomotic leakage, The mortality rate during hospitalization was higher than that in the limited period operation group (P0.05), but nausea, vomiting, pulmonary infection, postoperative intestinal obstruction, There was no significant difference in incisional infection (P0.05). The number of lymph node dissection in the limited operation group (14.8 鹵5.7) was significantly higher than that in the emergency operation group (10.6 鹵8.8) (P0.01) .The results of univariate analysis showed that the preoperative CEA CA19-9 increased ASA score 鈮，

本文編號：2078715