目的 探討原發性空、回腸腫瘤的臨床表現、病理類型及其特點，為進一步提高對該類疾病的診斷水平提供臨床經驗。 方法 對2003年1月－2012年11月62例原發性空、回腸腫瘤患者的臨床資料進行回顧性分析。 結果 患者年齡（55 ± 16）歲，＞40歲者占83.9%。良性腫瘤9例，惡性腫瘤53例，良、惡性之比為1︰5.9。53例惡性腫瘤包括惡性間質瘤26例，惡性淋巴瘤15例，腺癌9例，另有平滑肌肉瘤、肉瘤樣癌、濾泡樹突狀細胞肉瘤各1例；主要臨床表現為腹痛（44/62，71.0%）、腸梗阻（22/62，35.5%）、貧血（16/62，25.8%）、腹脹不適（11/62，17.7%）、消化道出血（10/62，16.1%）、腹部包塊（8/62，12.9%）。術前小腸腫瘤的診斷率僅為25.8%（16/62），46例患者經手術探查及術后病理檢查得以確診。 結論 原發性空、回腸腫瘤缺乏特異性臨床表現，早期診斷相當困難，術前誤診率高，高度警惕和加深對該疾病的認識十分重要。
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.