结肠镜非透视下金属支架置人术在梗阻性结直肠癌患者急诊处理中的应用

目的探讨结肠镜非透视下金属支架置入术应用于梗阻性结直肠癌患者急诊处理的安全性和有效性。方法回顾性分析2010年1月至2012年6月间在第二军医大学长海医院接受结肠镜非透视下金属支架置入术治疗42例梗阻性结直肠癌患者的临床资料。手术采用改良双人肠镜操作法,结肠镜进镜至肿瘤部位,暴露肿瘤狭窄孔,经活检孔插入黄斑马导丝,沿导丝将选择好的金属支架及置人器置人并通过狭窄段,释放支架并调整输送器使支架置于目的位置。结果42例梗阻性结直肠癌患者中直肠癌19例,乙状结肠癌9例,降结肠癌8例,结肠脾曲癌1例,结肠肝曲癌3例,升结肠癌2例。支架置入成功率100％,支架置入操作时间1．1～51．0（11．8~10．4）min。除l例患者因心力衰竭于术后第2天死亡外,其余4l例患者术后第1天即可进流质饮食,术后2~3d出院,术后临床症状缓解率为100％。术中无一例患者发生穿孔,术后3例患者有轻微出血,经药物治疗后好转。结论肠镜镜非透视下金属支架置入术在梗阻性结直肠癌患者急诊处理中安全、有效、省时。

Emergence application of colonoscopic placement of self-expandable metal stent without fluoroscopic monitoring

Objective To evaluate the efficacy and safety of colonoscopy-guided placement of self-expandable metallic stent without fluoroscopic monitoring in the emergence management for acute malignant colorectal obstruction. Methods Clinical data of 42 patients（24 males and 18 females with a mean age of 64.3 years） undergoing eolonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring for acute malignant colorectal obstruction between January 2010 and June 2012 were reviewed retrospectively. Results The obstruction was located in the rectum（n=19）, sigmoid （n=9）, descending colon （n=8）, splenic flexure （n=l）, hepatic flexure （n=3）, and ascending colon（n=2）. Technical success was achieved in all the 42 patients（ 100% ）. The mean time of operation was（ll.8＋10.4） min （range 1.1-51.0 min）. No serious procedure-related complication occurred. Minor bleeding occurred in 3 cases（7.1%）. One patient died on the second day after surgery because of heart failure. Conclusions Colonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring in emergence management for acute malignant colorectal obstruction is effective and safe with shorter operative time.