内镜下肠道金属支架治疗结直肠恶性梗阻的临床疗效

Safety and efficacy of endoscopic self-expandable metal stent implantation for malignant colonic obstruction

摘要:

目的  探讨内镜下肠道金属支架安置术（SEMs）治疗结直肠恶性肿瘤梗阻的疗效和安全性。方法  纳入2011年1月-2014年5月南华大学附属第一医院消化内科和胃肠外科收治的因结直肠恶性梗阻行SEMs的患者108例，回顾分析该技术的临床成功率及短期并发症发生情况。结果  108例患者中，金属支架安置成功率92.59%（100/108）。术后并发症以腹痛、穿孔及出血为主，发生率分别为16.67%（18/108）、7.41%（8/108）及6.48%（7/108），穿孔均行急诊手术治疗，其他均自行缓解。结论  肠道SEMs成功率高，可以有效缓解结直肠恶性梗阻，不仅可以作为姑息性治疗的手段，还可以作为外科手术的桥梁，提高患者生存质量，临床上值得推广。

Abstract:

Objective To evaluate the safety and efficacy of endoscopic implantation of self-expandable metallic stent (SEMs) for malignant colorectal obstruction. Methods A total of 108 patients who had undergone endoscopic SEMs implantation for malignant colonic obstruction from January 2011 to May 2014 were enrolled. The clinical success rates and the complications were reviewed. Results The clinical success rates were 92.59% (100/108). Abdominal pain, perforation and bleeding were the most common post-procedure complications, the rates of which were 16.67% (18/108), 7.41% (8/108), 6.48% (7/108), respectively. The abdominal pain in most patients was self-relieving except for 6 patients with perforation of colon. Patients with perforation were cured by emergency surgery. The 7 patients developing bleeding recovered themselves. Conclusion The success rate of endoscopic SEMs implantation is satisfactory in the study. As a bridge to surgery or a palliative care method, endoscopic SEMs implantation is effective and safe for malignant colorectal obstruction.