ObjectiveTo compare the short- and long-term effects of emergency surgery (ES) and self-expanding metal stent (SEMS) in treatment of malignant left-sided colonic obstruction.MethodsThe patients with malignant left-sided colonic obstruction who met the inclusion and exclusion criteria in the Third Affiliated Hospital of Soochow University from October 2010 to October 2020 were retrospectively collected and divided into ES group (n=43) and SEMS group (n=22). The baseline data, surgical data, postoperative data, and prognosis (overall survival and relapse free survival) were compared, and the risk factors of tumor recurrence after surgery were further analyzed by Cox proportional hazards regression model. ResultsIn this study, 65 cases of malignant left-sided colonic obstruction were included, including 43 cases in the ES group and 22 cases in the SEMS group. There were no statistical differences in the baseline data of the two groups (P>0.05). There were no significant differences in the incidence of postoperative complications [13.6% (3/22) vs. 23.3% (10/43), P=0.555], recurrence rate [40.9% (9/22) vs. 37.2% (16/43), P=0.772], and rate of receiving postoperative chemotherapy [68.2% (15/22) vs. 48.8% (21/43), P=0.138] between the SEMS group and ES group. Compared with the ES group, although the median hospitalization time was longer (20 d vs. 12 d, P=0.001), and the median hospitalization cost was higher (65 033 yuan vs. 40 045 yuan, P=0.001), the stoma rate of the SEMS group was lower [36.4% (8/22) vs. 88.4% (38/43), P=0.001], and the minimally invasive (laparoscopic) rate was higher [36.4% (8/22) vs. 7.0% (3/43), P=0.008]. There were no significant differences in the 4-year cumulative overall survival (46.9% vs. 48.4%, P=0.333) and 4-year cumulative relapse free survival (36.2% vs. 44.8%, P=0.724) between the SEMS group and ES group, but the overall survival of the SEMS group was better than that of the ES group for the patients with stage Ⅲ–Ⅳ (χ2=4.644, P=0.047). Multivariate analysis of Cox proportional hazards regression model showed that increased TNM stage increased the risk of postoperative tumor recurrence of patients with malignant left-sided colonic obstruction [HR=2.092, 95%CI (1.261, 3.469), P=0.004]. ConclusionsShort- and long-term effects of ES and SEMS in treatment of malignant left-sided colonic obstruction are equivalent. Although SEMS mode has a longer hospital stay and higher hospitalization costs, stoma rate is lower and laparoscopic surgery rate is higher. Overall survival of SEMS mode in treatment malignant left-sided colonic obstruction patients with stage Ⅲ–Ⅳ is better.
ObjectiveTo evaluate safety and effectiveness of stent placement and emergency surgery in treatment of proximal colon cancer obstruction.MethodsThe PubMed, Embase, Cochrane Library, ClinicalTrials, CNKI, CBM, Wanfang Data, etc. were searched comprehensively. The literatures of Chinese and English randomized controlled trial and retrospective comparative study of stent placement and emergency surgery for the proximal colon cancer obstruction were retrieved. The RevMan 5.3 and Stata 12.0 softwares were used. The meta-analysis was made on the safety and effectiveness of these two treatments.ResultsA total of 9 literatures involving 636 patients were included, all of them were the retrospective studies, 4 of them only reported the clinical success rate and technical success rate. The technical success rate of stent placement was 0.94 [95% CI (0.91, 0.96)]. The clinical success rate was 0.90 [95% CI (0.87, 0.93)]. Compared with the emergency surgery group, the total complication rate and the temporary stoma rate were lower [OR=0.32, 95% CI (0.11, 0.94), P=0.04; OR=0.18, 95% CI (0.05, 0.65), P=0.009] and the hospital stay was shorter [MD=–2.97, 95% CI (–4.52, –1.41), P=0.000 2] in the stent placement group. The perioperative mortality rate, laparoscopic surgery rate, 5-year disease-free survival rate, and 5-year overall survival rate had no significant differences between these two groups (P>0.05).ConclusionCompared with emergency surgery, endoscopic stent placement for treatment of proximal colon cancer obstruction has a lower incidence of complications, temporary colostomy rate, shorter hospital stay, and it has no significant differences in mortality, laparoscopic surgery rate, and survival rate.
Objective To evaluate and compare the outcomes of simple closed reduction, selective fragment excision after closed reduction, and emergency fragment excision and reduction in the treatment of Pipkin type I fracture of femoral head associated with posterior dislocation of the hip. Methods Between January 2002 and January 2008, 24 patients with Pipkin type I fracture of the femoral head associated with posterior dislocation of the hip were treated with simple closed reduction (closed reduction group, n=8), with selective fragment excision after closed reduction (selective operation group, n=8), and with emergency fragment excision and reduction (emergency operation group, n=8). In the closed reduction group, there were 6 males and 2 females with an average age of 37.6 years (range, 19-56 years); injuries were caused by traffic accident in 6 cases, by fall ing from height in 1 case, and by crushing in 1 case with a mean disease duration of 3.1 hours (range, 1.0-7.5 hours); and the interval from injury to reduction was (4.00 ± 2.14) hours. In the selective operation group, there were 7 males and 1 female with an average age of 37.3 years (range, 21-59 years); injuries were caused by traffic accident in 7 cases and by fall ing from height in 1 case with a mean disease duration of 3.2 hours (range, 1.0-6.0 hours); and the interval from injury to reduction was (3.90 ± 1.47) hours. In the emergency operation group, there were 5 males and 3 females with an average age of 35.5 years (range, 20-58 years); injuries were caused by traffic accident in 5 cases, by fall ing from height in 1 case, and by crushing in 2 cases with a mean disease duration of 3.3 hours (range, 1.5-6.5 hours); and the interval from injury to open reduction was (5.10 ± 2.04) hours. There was no significant difference in the age, gender, disease duration, and interval from injury to reduction among 3 groups (P gt; 0.05). Results All wounds in selective operation group and emergency operation group healed primarily. All the patients were followed up 24 to 58 months (mean, 38.7 months). According to Thompson-Epstein system, the excellent and good rates were 50.0% (4/8) in the closed reduction group, 87.5% (7/8) in the selective operation group, and 87.5% (7/8) in the emergency operation group at 24 months after operation, showing significant difference among 3 groups (χ2=9.803, P=0.020). Heterotopic ossification was found in 1 case (12.5%) of the closed reduction group, in 4 cases (50.0%) of the selective operation group, and in 4 cases (50.0%) of the emergency operation group, and avascular necrosis of femoral head was found in 2 cases (25.0%) of the closed reduction group; there was no significant difference in compl ications among 3 groups (P gt; 0.05). Conclusion The treatment of Smith-Petersen approach and fragment excision by selective operation or emergency operation has similar outcome, which are better than the treatment of simple closed reduction.
ObjectiveThe aim of this current meta-analysis is to evaluate the efficacy and safety of selective surgery after colonic stenting versus emergency surgery for acute obstructive colorectal cancer.MethodsThe studies published from January 1, 2000 to July 31, 2018 were searched from Pubmed, Embase, Cochrane Library, CNKI, Wanfang database, and VIP database. RevMan 5.3 software was used for data analysis.ResultsA total of 21 studies were included in this meta-analysis. Compared to emergency surgery, selective surgery after colonic stenting had significant lower mortality rate [OR=0.44, 95% CI was (0.26, 0.73), P<0.05], permanent stoma rate [OR=0.46, 95% CI was (0.23, 0.94), P<0.05], complication rate [OR=0.47, 95% CI was (0.35, 0.63), P<0.05], and wound infection rate [OR=0.40, 95% CI was (0.25, 0.65), P<0.05）], but had significant higher primary anastomosis rate [OR=3.30, 95% CI was (2.47, 4.41), P<0.05] and laparoscopic surgery rate [OR=12.55, 95% CI was (3.64, 43.25), P<0.05]. But there was no significant differences between the two groups as to anastomotic leak rate [OR=0.86, 95% CI was (0.48, 1.55), P>0.05].ConclusionsSelective surgery after colonic stenting can be identified in a reduced incidence of mortality rate, complication rate, permanent stoma rate, and wound infection rate, and also can increase primary anastomosis rate and laparoscopic surgery rate. Thus, for acute obstructive colorectal cancer, selective surgery after colonic stenting is better than emergency surgery.
ObjectiveTo evaluate the role of triclosan-coated polyglactin 910 suture in reducing wound infections of emergency gastrointestinal surgeries. MethodsThis was a prospective, randomized, controlled, single center study. From May 2009 to August 2010, 412 patients underwent emergency gastrointestinal operations in our department, 198 of them were chose randomly as experimental group using triclosancoated polyglactin 910 suture for abdominal wall closure， 214 using traditional braiding suture were taken as control. The risk factors for wound healing were analyzed, and wound infection rate was compared between two groups. ResultsThere were no significant differences of gender, age, body mass index, combined diabetes, use of immunosuppressant, and glucocorticoid steroid, type of incision, intraoperative bleeding volume, and operation time between two groups (Pgt;0.05). Wound infection rate of experimental group 〔3.0% (6/198）〕 was significantly lower than that of control group 〔11.7% (25/214), Plt;0.001〕. Especially in subgroup of type Ⅲ incision and operative time more than 120 min, wound infection rate was significantly different between experimental group and control group 〔3.5%(5/141) versus 14.3%(22/154); 3.3%(2/60) versus 21.2%(11/52) respectively, Plt;0.001〕. ConclusionTriclosancoated polyglactin 910 suture can reduce wound infection rate of gastrointestinal emergency operations, especially with type Ⅲ incision and operation time ≥120 min.