Caceres Aileen, Zhou Qin, Iasonos Alexia, Gerdes Hans, Chi Dennis S, Barakat Richard R
Gynecology Service, Department of Surgery, Memorial-Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
Gynecol Oncol. 2008 Mar;108(3):482-5. doi: 10.1016/j.ygyno.2007.11.035. Epub 2008 Jan 10.
Malignant large-bowel obstruction in the acute setting is considered a surgical emergency. Surgical intervention has been the standard treatment for patients presenting with large-bowel obstruction. Surgery in severely ill patients, however, can be associated with significant morbidity and mortality. Our objective was to review and update our experience with colonic stent placement for patients presenting with a large-bowel obstruction due to recurrent gynecologic malignancy.
We reviewed the records of all patients with gynecologic cancer who underwent colorectal stent placement for palliation of a large-bowel obstruction from January 2001 to October 2006.
Thirty-five patients were identified--25 patients had recurrent ovarian cancer, 7 patients had recurrent endometrial cancer, 2 patients had primary peritoneal carcinoma, and 1 patient had recurrent cervical cancer. The median age at the time of stent placement was 54 years (range, 21-79). The median length of the large-bowel obstruction was 6.5 cm (range, 1-20 cm). Six patients had a lumen of 1 to 2 mm before stent placement, while 29 patients had complete obstruction and needed balloon dilatation before deployment of the stent. Twenty-seven patients (77%) underwent successful stent placement and immediate decompression at the time of colorectal stent placement. Of the patients who had successful stent placement, 9 (33%) underwent additional surgery to relieve obstruction-drainage gastrotomy, 3; colostomy, 4; and stent revision, 2. Eight patients (23%) had failed stent placement secondary to non-traversable strictures and angulation of the bowel. Of these 8 patients, 5 needed colostomy and 3 needed gastrotomy. Of the 27 patients who underwent successful stent placement, the median survival after placement was 7.7 months (95% CI, 3.19-11.9 months).
In the management of patients with large-bowel obstructions due to recurrent gynecologic cancer, colonic stents appear to be a reasonable option that may enable patients to avoid major surgery.
急性情况下的恶性大肠梗阻被视为外科急症。手术干预一直是大肠梗阻患者的标准治疗方法。然而，病情严重患者的手术可能会伴有显著的发病率和死亡率。我们的目的是回顾并更新我们对因复发性妇科恶性肿瘤导致大肠梗阻的患者进行结肠支架置入术的经验。
我们回顾了2001年1月至2006年10月期间所有因大肠梗阻而行结肠支架置入术以缓解症状的妇科癌症患者的记录。
共确定了35例患者——25例患有复发性卵巢癌，7例患有复发性子宫内膜癌，2例患有原发性腹膜癌，1例患有复发性宫颈癌。支架置入时的中位年龄为54岁（范围21 - 79岁）。大肠梗阻的中位长度为6.5厘米（范围1 - 20厘米）。6例患者在支架置入前管腔为1至2毫米，而29例患者完全梗阻，在支架置入前需要球囊扩张。27例患者（77%）在结肠支架置入时成功置入支架并立即解除梗阻。在成功置入支架的患者中，9例（33%）接受了额外手术以缓解梗阻——胃造瘘术3例；结肠造口术4例；支架修复术2例。8例患者（23%）因不可穿越的狭窄和肠管成角导致支架置入失败。在这8例患者中，5例需要结肠造口术，3例需要胃造瘘术。在成功置入支架的27例患者中，置入后的中位生存期为7.7个月（95%可信区间，3.19 - 11.9个月）。
在因复发性妇科癌症导致大肠梗阻的患者管理中，结肠支架似乎是一种合理的选择，可能使患者避免大手术。
