van Hooft J E, Bemelman W A, Fockens P
Medisch Spectrum Twente, afd. Inwendige Geneeskunde/Maag-, Darmen Leverziekten, Postbus 50.000, 7500 KA Enschede.
Ned Tijdschr Geneeskd. 2007 Jun 2;151(22):1249-51.
Conventionally, patients with acute left-sided malignant colonic obstruction are treated with emergency surgery to restore luminal patency. These emergency operations have a mortality rate of 15-34% and a morbidity rate of 32-64% despite advances in perioperative care. Since the early 1990s, colonic stenting has been introduced, mainly in the left-sided colon, to restore luminal patency. In uncontrolled studies, stent placement before elective surgery has been suggested to improve the patient's clinical condition, thus decreasing mortality, morbidity, and the number of colostomies. To date, only one randomised controlled trial has been published: this study had several limitations, due to which there is still insufficient evidence. Therefore, a large-scale comparison between these two treatment algorithms has been initiated in a prospective multicentre randomised setting with respect to quality of life, morbidity, mortality, and healthcare costs.
传统上,急性左侧恶性结肠梗阻患者接受急诊手术以恢复管腔通畅。尽管围手术期护理有所进步,但这些急诊手术的死亡率为15% - 34%,发病率为32% - 64%。自20世纪90年代初以来,结肠支架置入术已被引入,主要用于左侧结肠,以恢复管腔通畅。在非对照研究中,有人建议在择期手术前放置支架以改善患者的临床状况,从而降低死亡率、发病率和结肠造口术的数量。迄今为止,仅发表了一项随机对照试验:该研究存在若干局限性,因此仍然证据不足。因此,已在一项前瞻性多中心随机研究中对这两种治疗方案在生活质量、发病率、死亡率和医疗费用方面展开大规模比较。