自膨式金属支架植入术治疗急性左半结直肠癌性梗阻
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摘要
目的探讨内镜联合透视下自膨式金属支架植入术治疗急性左半结直肠癌性梗阻的应用价值。方法回顾性分析接受内镜联合透视下自膨式金属支架植入术治疗的49例左半结直肠癌性梗阻患者的临床资料。结果于48例患者成功植入支架,技术成功率为97.96%(48/49);1例因导丝无法通过狭窄段而转为外科急诊手术。植入支架后,47例梗阻症状明显改善;1例未改善而转为外科急诊手术。术后1例发生肠穿孔,5例便中带少量鲜血,经对症治疗后均好转;2例发生支架脱落。21例患于植入支架解除肠梗阻后接受结肠癌根治术,Ⅰ期手术成功率100%(21/21)。结论内镜联合透视下自膨式金属支架植入术解除左半结直肠癌性梗阻安全、有效。
Objective To investigate the application value of self-expanding metallic stent(SEMS) implantation under fluoroscopy combined with endoscopy for acute left-side malignant colorectal obstruction. Methods Clinical date of 49 patients with left-side malignant colorectal obstruction who underwent SEMS implantation under fluoroscopy combined with endoscopy were retrospectively analyzed. Results Stents were implanted successfully in 48 patients. The technical success rate was 97.96%(48/49). One patient was transferred to emergency surgery because the guidewire could not pass through the stenosis. After stent implantation, colorectal obstruction relieved in 47 patients, while one patient was transferred to emergency surgery for unimproved obstruction. Postoperative perforation occurred in one patient after stent implantation, while a small amount of blood in excrement were found in 5 patients and then relieved after symptomatic treatment. Stent migration occurred in 2 patients. Totally 21 patients received tumor resection procedure after the symptoms of intestinal obstruction remission, and the success rate of surgery was 100%(21/21). Conclusion SEMS implantation under fluoroscopy combined with endoscopy is safe and effective to alleviate acute left-side malignant colorectal obstruction.
Objective To investigate the application value of self-expanding metallic stent(SEMS) implantation under fluoroscopy combined with endoscopy for acute left-side malignant colorectal obstruction. Methods Clinical date of 49 patients with left-side malignant colorectal obstruction who underwent SEMS implantation under fluoroscopy combined with endoscopy were retrospectively analyzed. Results Stents were implanted successfully in 48 patients. The technical success rate was 97.96%(48/49). One patient was transferred to emergency surgery because the guidewire could not pass through the stenosis. After stent implantation, colorectal obstruction relieved in 47 patients, while one patient was transferred to emergency surgery for unimproved obstruction. Postoperative perforation occurred in one patient after stent implantation, while a small amount of blood in excrement were found in 5 patients and then relieved after symptomatic treatment. Stent migration occurred in 2 patients. Totally 21 patients received tumor resection procedure after the symptoms of intestinal obstruction remission, and the success rate of surgery was 100%(21/21). Conclusion SEMS implantation under fluoroscopy combined with endoscopy is safe and effective to alleviate acute left-side malignant colorectal obstruction.
引文
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[11] Sebastian S, Johnston S, Geoghegan T, et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol, 2004,99(10):2051-2057.
[12] Lee HJ, Hong SP, Cheon JH, et al. Clinicaloutcomes of self-expandable metal stents for malignant rectal obstruction. Dis Colon Rectum, 2018,61(1):43-50.
[13] Datye A, Hersh J. Colonic perforation after stent placement for malignant colorectal obstruction—causes and contributing factors. Minim Invasive Ther Allied Technol, 2011,20(3):133-140.
[14] Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: Long-term outcomes and complication factors. Gastrointest Endosc, 2010,71(3):560-572.
[2] Winner M, Mooney SJ, Hershman DL, et al. Incidence and predictors of bowel obstruction in elderly patients with stage IV colon cancer:A population-based cohort study. JAMA Surg, 2013,148(8):715-722.
[3] Jullumstro E, Wibe A, Lydersen S, et al. Colon cancer incidence, presentation, treatment and outcomes over 25 years. Colorectal Dis, 2011,13(5):512-518.
[4] Leitman IM, Sullivan JD, Brams D, et al. Multivariate analysis of morbidity and mortality from the initial surgical management of obstructing carcinoma of the colon.Surg Gynecol Obstet, 1992,174(6):513-518.
[5] Alves A, Panis Y, Mathieu P, et al. Postoperative mortality and morbidity in French patients undergoing colorectal surgery: Results of a prospective multicenter study. Arch Surg, 2005,140(3):278-283.
[6] Ye GY, Cui Z, Chen L, et al. Colonic stenting vs emergent surgery for acute left-sided malignant colonic obstruction:A systematic review and meta-analysis. World J Gastroenterol, 2012,18(39):5608-5615.
[7] Imai M, Kamimura K, Takahashi Y, et al. The factors influencing long-term outcomes of stenting for malignant colorectal obstruction in elderly group in community medicine. Int J Colorectal Dis, 2018,33(2):189-197.
[8] Cirocchi R, Farinella E, Trastulli S, et al. Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: A systematic review and meta-analysis. Surg Oncol, 2013,22(1):14-21.
[9] Dohmoto M. New method: Endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Dig, 1991,2(3):1507-1512.
[10] 张杰,陈婧,张谨芬,等.结直肠金属支架置入术对左半结肠癌所致肠梗阻的治疗价值.中华消化内镜杂志,2012,29(2):85-87.
[11] Sebastian S, Johnston S, Geoghegan T, et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol, 2004,99(10):2051-2057.
[12] Lee HJ, Hong SP, Cheon JH, et al. Clinicaloutcomes of self-expandable metal stents for malignant rectal obstruction. Dis Colon Rectum, 2018,61(1):43-50.
[13] Datye A, Hersh J. Colonic perforation after stent placement for malignant colorectal obstruction—causes and contributing factors. Minim Invasive Ther Allied Technol, 2011,20(3):133-140.
[14] Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: Long-term outcomes and complication factors. Gastrointest Endosc, 2010,71(3):560-572.