Xinopoulos D, Dimitroulopoulos D, Theodosopoulos T, Tsamakidis K, Bitsakou G, Plataniotis G, Gontikakis M, Kontis M, Paraskevas I, Vassilobpoulos P, Paraskevas E
Gastroenterology Unit, Saint Savvas Cancer Hospital, Parnassou 35, 152 34, Athens, Greece.
Surg Endosc. 2004 Mar;18(3):421-6. doi: 10.1007/s00464-003-8109-x. Epub 2004 Jan 23.
The aim of the present study was to compare the efficacy, safety, and cost of endoscopic palliative treatment with selfexpanding metallic stents with that of stoma creation in the management of inoperable malignant colonic obstructions.
A total of 30 patients with inoperable malignant partial obstruction (due to metastases, hemodynamic instability, or pulmonary instability) in the left colon arising from colorectal or ovarian cancer were included in the study. Fifteen were randomized to undergo palliative metallic colonic stent placement and 15 to undergo stoma creation. The efficacy and safety of the two methods was compared. A cost-effectiveness analysis was also performed, including the cost of postinterventional care.
Stents were placed successfully in 14 of 15 patients. In one patient with obstruction of a tortuous rectosigmoid flexure colon, stenting was not possible; this patient was excluded from the study. During the follow-up period, a moderate, nonocclusive ingrowth of tumor into the stent lumen was observed in six patients; they were all treated with internal laser ablation. The cost-effectiveness analysis showed that although the stoma creation procedure was less expensive, the total difference in average costs for the two methods was 6.9% (132 Euros).
Self-expanding metallic stent placement is a palliative alternative to colostomy for patients with inoperable malignant colonic strictures. This treatment option provides a better quality of life for the patient, without the psychological repercussions of a colostomy, and it appears to be cost-effective.
本研究旨在比较自膨式金属支架内镜姑息治疗与造口术在不可切除的恶性结肠梗阻治疗中的疗效、安全性和成本。
本研究纳入了30例因结直肠癌或卵巢癌导致左半结肠不可切除的恶性部分梗阻（由于转移、血流动力学不稳定或肺部不稳定）的患者。15例患者随机接受姑息性结肠金属支架置入术，15例接受造口术。比较了两种方法的疗效和安全性。还进行了成本效益分析，包括介入后护理的成本。
15例患者中有14例成功置入支架。1例乙状结肠结肠迂曲梗阻患者无法进行支架置入；该患者被排除在研究之外。在随访期间，6例患者观察到肿瘤中度、非闭塞性向内生长进入支架腔；他们均接受了内部激光消融治疗。成本效益分析表明，尽管造口术成本较低，但两种方法的平均成本总差异为6.9%（132欧元）。
对于不可切除的恶性结肠狭窄患者，自膨式金属支架置入术是结肠造口术的一种姑息性替代方法。这种治疗选择为患者提供了更好的生活质量，没有结肠造口术带来的心理影响，而且似乎具有成本效益。
