Desroches E, Faucheron J L, Sengel C, Lachachi F, Risse O, Delannoy P, Arvieux C, Rolachon A, Létoublon C
Service de Chirurgie Générale et Digestive, Hôpital Michallon, Grenoble.
Ann Chir. 1999;53(10):1029-32.
To report our preliminary experience with self-expandable metal stent in the treatment of acute malignant obstruction of the left colon and to review the literature on this specific subject.
From March to September 1999, 8 consecutive patients with a mean age 71 were admitted as an emergency for acute malignant obstruction of the left colon. A self-expandable metal stent was inserted under radioscopic and, in 4 cases, endoscopic guidance. The patients then underwent bowel preparation before operation, if required.
There was no mortality. Bowel preparation was satisfactory in 6 cases. Complications occurred in 1 patient, who was operated on day one for peritonitis due to perforation of the tumour by the prosthesis inserted after dilatation. Another six patients were operated: 2 had resection followed by anastomosis; 3 had resection and anastomosis protected by ileostomy; 2 had Hartmann's procedure. The last patient retained the prosthesis as palliation. In the literature, self-expandable metal stent application in obstructed carcinoma of the left colon gives satisfactory results.
Based on our experience and a review of the literature, we provide practical recommendations when inserting self-expandable metal stents for acute malignant left colonic obstruction.
报告我们使用自膨式金属支架治疗左半结肠癌急性恶性梗阻的初步经验，并回顾关于该特定主题的文献。
1999年3月至9月，连续8例平均年龄71岁的患者因左半结肠癌急性恶性梗阻作为急诊入院。在X线透视引导下插入自膨式金属支架，4例在内镜引导下插入。然后根据需要，患者在手术前进行肠道准备。
无死亡病例。6例肠道准备满意。1例出现并发症，该患者在扩张后插入的假体导致肿瘤穿孔，于术后第1天因腹膜炎接受手术。另外6例患者接受手术：2例行切除吻合术；3例行切除吻合术并辅以回肠造口术保护；2例行哈特曼手术。最后1例患者保留假体作为姑息治疗。文献报道，自膨式金属支架应用于左半结肠癌梗阻取得了满意的效果。
基于我们的经验和文献回顾，我们给出了插入自膨式金属支架治疗左半结肠癌急性恶性梗阻的实用建议。
