Law Wai Lun, Choi Hok Kwok, Lee Yee Man, Chu Kin Wah
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
Dis Colon Rectum. 2004 Jan;47(1):39-43. doi: 10.1007/s10350-003-0005-x. Epub 2004 Jan 14.
This study was designed to evaluate the outcomes of self-expanding metallic stents as a palliative treatment for malignant obstruction of the colon and rectum.
The insertion of self-expanding metallic stents was attempted for palliation in 52 patients (33 males; mean age, 66.5 +/- 16.4 years) with colorectal obstruction caused by advanced malignancies. The stents were inserted under endoscopic and fluoroscopic guidance. The data on the success of the procedure, the complications, and the outcomes of the patients were collected prospectively.
Thirty patients had locally advanced or disseminated primary colorectal cancers, and 22 had recurrent cancer of colorectal or other primaries. Successful insertion of the stent was achieved in 50 patients. The median survival of the patients was 88 (range, 3-450) days. Complications occurred in 13 patients (25 percent). These included perforation of the colon (n=1), migration or dislodgement of the stents (n=8), severe tenesmus (n=1), colovesical fistula (n=1), and tumor ingrowth (n=2). Insertion of a second stent was required in eight patients. Subsequent operations were performed in nine patients, and stoma creation was required in seven patients.
Self-expanding metallic stents are highly effective in relieving malignant colorectal obstruction. The complication rate is acceptable and palliation can be achieved in the majority of the patients without a stoma.
本研究旨在评估自膨式金属支架作为结肠和直肠恶性梗阻姑息治疗的效果。
对52例（33例男性；平均年龄66.5±16.4岁）由晚期恶性肿瘤引起的结直肠梗阻患者尝试置入自膨式金属支架进行姑息治疗。支架在内镜和透视引导下置入。前瞻性收集手术成功率、并发症及患者结局的数据。
30例患者患有局部晚期或播散性原发性结直肠癌，22例患有结直肠癌或其他原发性肿瘤复发。50例患者成功置入支架。患者的中位生存期为88天（范围3 - 450天）。13例患者（25%）出现并发症。这些并发症包括结肠穿孔（n = 1）、支架移位或脱落（n = 8）、严重里急后重（n = 1）、结肠膀胱瘘（n = 1）和肿瘤长入（n = 2）。8例患者需要置入第二个支架。9例患者进行了后续手术，7例患者需要造口。
自膨式金属支架在缓解结直肠恶性梗阻方面非常有效。并发症发生率可以接受，大多数患者无需造口即可实现姑息治疗。
