Gukovsky-Reicher Sofiya, Lin Richard M, Sial Shahid, Garrett Benedict, Wu Dennis, Lee Tonny, Lee Hanson, Arnell Tracey, Stamos Michael J, Eysselein Victor E
Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA.
MedGenMed. 2003 Jan 10;5(1):16.
Management of malignant gastrointestinal obstruction presents a significant challenge. Most patients are in a profoundly decompensated state due to underlying malignancy and are not ideal candidates for invasive surgical procedures. In recent years, self-expandable metal stents (SEMS) have emerged as an effective and safe, less invasive alternative for the treatment of malignant intestinal obstruction. Here we report a retrospective analysis of 59 SEMS placed for gastroduodenal and colorectal obstruction in 48 patients at Harbor-UCLA Medical Center during the last 5 years, as well as review the literature published on SEMS placement. Technical and clinical success rates were approximately 92% and 80%, respectively. The majority of patients tolerated oral food intake by 36 hours after SEMS. There were no major complications of perforation, bleeding, or death. Thirteen patients had obstructive symptom recurrence, which in most cases was successfully managed with additional endoscopic interventions. Our data confirm SEMS efficacy in palliation of malignant intestinal obstruction with lower rates of major complications than previously reported.
恶性胃肠道梗阻的管理是一项重大挑战。大多数患者由于潜在的恶性肿瘤而处于严重失代偿状态，并非侵入性外科手术的理想候选者。近年来，自膨式金属支架（SEMS）已成为治疗恶性肠梗阻的一种有效、安全且侵入性较小的替代方法。在此，我们报告对过去5年在哈伯-加州大学洛杉矶分校医学中心为48例患者放置的59个用于胃十二指肠和结肠直肠梗阻的SEMS进行的回顾性分析，并回顾已发表的关于SEMS放置的文献。技术成功率和临床成功率分别约为92%和80%。大多数患者在放置SEMS后36小时能耐受经口进食。未发生穿孔、出血或死亡等重大并发症。13例患者出现梗阻症状复发，大多数情况下通过额外的内镜干预成功处理。我们的数据证实了SEMS在缓解恶性肠梗阻方面的疗效，且主要并发症发生率低于先前报道。
