Song H-Y, Kim J H, Shin J H, Kim H-C, Yu C S, Kim J-C, Kang S-G, Yoon C J, Lee J Y, Koo J H, Lee K-H, Kim J-K, Kim D H, Shin T-B, Jung G-S, Han Y-M
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Endoscopy. 2007 May;39(5):448-54. doi: 10.1055/s-2007-966270.
It is known that metal stent placement is safe, easy, and effective for the treatment of malignant colorectal obstruction, but these stents are associated with delayed complications of tumor ingrowth and stent migration. The aim of this study was to prospectively investigate the technical feasibility, clinical effectiveness, and safety of a dual-design colorectal stent (consisting of an outer stent and an inner bare nitinol stent) in patients with malignant colorectal obstruction.
Placement of the dual stent using a 4.5-mm stent delivery system was attempted in 151 patients with malignant colorectal obstruction, either before surgery (n = 50) or for palliation (n = 101). Multivariate logistic regression analysis was used to identify risk factors associated with complications.
Stent placement was technically successful in 145/151 patients (96%). Of the patients who had a technically successful placement, bowel obstruction resolved within 2 days after stent placement in 48/50 (96%) of the patients in the bridge-to-surgery group and in 87/95 (92%) of the patients in the palliative group. Perforation occurred in 16 patients, incomplete stent expansion in eight patients, stent migration in four patients, tumor overgrowth in five patients, severe rectal pain in five patients, and bleeding in eight patients. Complete obstruction was the only significant risk factor for perforation (odds ratio 6.88, 95% CI 2.04-23.17, P = 0.002). In the palliative group, the median survival was 152.0 days and the mean survival was 263.8 days.
The dual stent with a 4.5-mm stent delivery system is easy to insert, safe, and reasonably effective for the palliative treatment of malignant colorectal obstruction. However, a great deal of care is needed in its deployment because of the high rate of perforation.
已知金属支架置入术治疗恶性大肠梗阻安全、简便且有效，但这些支架与肿瘤长入和支架移位等延迟并发症相关。本研究的目的是前瞻性地调查双设计大肠支架（由外部支架和内部裸镍钛诺支架组成）用于恶性大肠梗阻患者的技术可行性、临床有效性和安全性。
使用4.5毫米支架输送系统对151例恶性大肠梗阻患者尝试置入双支架，其中50例在手术前置入，101例用于姑息治疗。采用多因素逻辑回归分析确定与并发症相关的危险因素。
145/151例患者（96%）支架置入术技术成功。在技术成功置入支架的患者中，桥接手术组48/50例（96%）患者和姑息治疗组87/95例（92%）患者的肠梗阻在支架置入后2天内缓解。16例患者发生穿孔，8例患者支架扩张不完全，4例患者支架移位，5例患者肿瘤过度生长，5例患者出现严重直肠疼痛，8例患者出血。完全梗阻是穿孔的唯一显著危险因素（比值比6.88，95%可信区间2.04 - 23.17，P = 0.002）。在姑息治疗组，中位生存期为152.0天，平均生存期为263.8天。
采用4.5毫米支架输送系统的双支架易于插入，对恶性大肠梗阻的姑息治疗安全且相当有效。然而，由于穿孔发生率高，在其置入过程中需要格外小心。
