近段结肠癌急性肠梗阻应用内镜下金属支架引流术的价值探讨

目的 评价内镜下金属支架引流术在近段结肠癌急性肠梗阻中的应用价值.方法 2004年9月至2010年6月中山医院内镜中心共81例近段结肠癌急性肠梗阻被纳入了研究,患者中男47例,女34例,平均年龄（66.2±7.5）岁.评价内镜下金属支架引流术的成功率、安全性、手术切除率.结果 患者中肿瘤部位包括：横结肠癌18例（22.2%）、肝曲癌42例（51.9%）、盲升结肠癌21例（25.9%）.支架置入成功率100%（81/81）,梗阻缓解率96.3%（78/81）.92.3%（72/78）患者在支架置入（8±1）d后接受了根治性手术,其中5例同时接受了肝转移灶的切除、3例接受了十二指肠部分切除.根治术后并发症发生率4.2%（3/72）,包括1例切口愈合不佳和2例心肺并发症,均经保守治疗后好转.无围手术期死亡率发生.结论 近段结肠癌急性肠梗阻的内镜下金属支架引流术安全、有效,经金属支架引流后,患者获得了根治性手术的机会,对于改善患者的预后具有较大的帮助,应作为首选的治疗方式.

Self-expanding metallic stents for acute obstruction of the proximal colorectal cancer

Objective To evaluate the efficacy of self-expanding metallic stents(SEMS)for acute proximal colon obstruction due to colon carcinoma.Methods From September 2004 to June 2010, a total of 81 patients(47 males and 34 females, aged 18-94 yr, mean 66.2 ± 7.5 yr)with acute proximal colon obstruction(proximal to spleen flex)caused by colon carcinoma were treated by SEMS.The success rate of stent drainage, safety of the procedure and the surgical removal rate of the carcinoma were evaluated.Results The tumors were located in transverse colon in 18(22.2%)patients, in hepatic flexure in 42 (51.9%)and in ascending colon in 21(25.9%).The success rate of stenting was 100%(81/81), and endoscopic decompression using SEMS placement was technically successful in 78 of 81 patients(96.3%).92.3%(72/78)patients underwent radical surgery 8 ± 1 days after stenting, among whom 5 underwent simultaneous hepatic metastasis foci resection and 3 others received partial resection of duodenum.Incidence of postoperative complications was 4.2%(3/72), including one case of poor healing and 2 cases of cardiopulmonary complications, which were all cured with conservative treatments.No perioperative death occurred.Conclusion Management of acute proximal colon obstruction due to colon carcinoma by using SEMS placement is effective and safe, which can be considered as a bridge method before curative surgery.