Comparative Study Of Stent Transitional Treatment And Emergency Surgery For Acute Malignant Ostruction Of Left Colon

Objective: To evaluate the efficiency,safety and cost-effectiveness of intestinal stent as a preoperative bridge in the treatment of acute left colorectal malignant obstruction.Methods : The clinical data of patients undergoing elective surgery and emergency surgery after self expanding metal stent implantation for acute malignant obstruction of the left colon in Affiliated Hospital of Guilin Medical College from January 2018 to December 2021 were collected retrospectively.According to the location of the tumor,it was divided into distal 1 / 3 of transverse colon,splenic flexure of colon,descending colon,descending sigmoid junction,sigmoid colon,straight sigmoid junction and rectum.The efficiency,safety and cost-effectiveness of the two groups were compared.Results: The technical success rate and clinical success rate of stenting in patients with left colon cancer were 100%(43/43).In 43 patients with successful stenting,3 cases had bloody stool after operation.There were 141 cases in the emergency operation group,of which 15 cases had complications,including 5cases of pulmonary infection,6 cases of anastomotic fistula and 4 cases of incision infection.The patients with anastomotic fistula underwent emergency laparotomy again;In patients with left colon cancer with obstruction,the primary resection rate in the elective operation group after intestinal stent was higher than that in the emergency operation group(97.7% vs 85.8%,P = 0.032);The primary anastomosis rate was higher(67.4% vs 40.4%,P = 0.002);The rate of laparoscopic surgery was higher(72.1% vs 36.2%,P < 0.001);The time of anal exhaust was earlier than that after emergency surgery(3.9 days vs 5.1 days,P < 0.001);Less intraoperative bleeding(30ml vs 50 ml,P = 0.02);The operation time was less(2.8h vs 3.4h,P < 0.001);There was no significant difference in total postoperative complications(7.0% vs 10.6%,P = 0.679);The fistula rate was low(32.6% vs 59.6%,P = 0.002);There was significant difference in treatment cost between the two groups(56000 yuan vs 65000 yuan,P < 0.01);The per capita treatment cost of the selective surgery group after stent was lower than that of the emergency surgery group(NPV = 8421 yuan),and the cost-effectiveness of the selective surgery group after stent was better than that of the emergency surgery group(BCR = 1.15,BCR > 1).Conclusions: 1.As a preoperative bridge,intestinal stent implantation is safe and effective in the treatment of malignant obstruction of left colon.2.Elective surgery is more beneficial than emergency surgery in patients with malignant obstruction of the left colon.3.The cost of elective surgery after stent implantation in patients with malignant obstruction of left colon is less than that of emergency surgery,and the cost-effectiveness of elective surgery group after stent implantation is better.