紧急情况下阻塞性结直肠癌的管理:最新情况
Efstathios T Pavlidis1, Ioannis N Galanis1, Theodoros E Pavlidis2
12 Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece.
World journal of gastrointestinal oncology
|April 5, 2024
概括
左侧结直肠癌阻塞的管理仍在争论中. 虽然内镜支架提供了侵入性较小的选择,但手术切除策略各不相同,强调个性化患者护理以获得最佳结果.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 结肠直肠手术 结肠直肠手术
背景情况:
- 大肠直肠癌经常出现阻塞,特别是在左侧,晚期 (II-IV).
- 临床表现,成像 (CT,PET/CT) 和结肠镜有助于诊断.
- 最佳的管理策略,平衡短期和长期结果尚未最终确定.
研究的目的:
- 审查和讨论目前阻塞性结肠直肠癌的管理策略.
- 为了比较手术与内镜干预对左侧和右侧阻塞的疗效.
- 评估微创技术和新辅助疗法的作用.
主要方法:
- 对阻塞性结直肠癌的临床表现,诊断方式和治疗选择的审查.
- 紧急手术,内镜解压 (支架/管道) 和选择性切除的比较.
- 讨论一阶段与两阶段切除,包括哈特曼手术.
- 对微创手术 (腹腔镜,机器人) 和损伤控制手术的评估.
- 考虑放压支架作为桥梁选择性手术和结合新辅助治疗.
主要成果:
- 左侧阻塞:紧急手术或内镜解压 (支架/管) 是主要选择. 一阶段切除 (带或不带口腔) 或两阶段切除 (哈特曼手术) 是手术选择. 初级解剖是方便的,但具有更高的风险.
- 右侧阻塞:一阶段的手术切除通常优先于内镜解压.
- 作为选择性手术的桥梁,减压支架可以减少与紧急手术相比的发病/死亡率,并且具有相似的中期存活率.
- 最少侵入性手术在管理膨胀结肠方面存在挑战.
- 新辅助性化疗/辐射结合支架可能会改善长期的瘤结果.
结论:
- 个性化管理计划对于阻塞性结直肠癌至关重要.
- 对于左侧阻塞,内镜支架是紧急手术的可行替代方案,作为选择性手术的桥梁.
- 右侧阻塞有利于手术切除.
- 需要进一步的研究来澄清微创手术的作用和优化新辅助策略.
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