Hahnemann University Hospital, Drexel University School of Medicine, Philadelphia, PA, USA.
Adv Ther. 2011 Feb;28(2):73-86. doi: 10.1007/s12325-010-0094-6. Epub 2011 Jan 6.
Colonic stents traditionally have been used for the management of colorectal cancer, either as a palliative treatment or as a bridge to surgery. More recently, colonic stents have also been advocated as part of the therapy of benign strictures. A number of colonic stents are available worldwide, four of which are made in the USA. These stents are classified as covered or uncovered, with similar clinical applications. Technical and clinical success rates are similar among these different stents, as well as the rate of complications, which mainly consist of obstruction and migration. The deployment systems utilize fluoroscopy, endoscopy, or both. More recently, stents became available that are deployed "through the scope" (TTS) making the procedure faster. However, this advance does not exclude the use of fluoroscopy, particularly in those cases where the direct visualization of the proximal end of the stricture is absent. The increasing experience in the management of colorectal cancer with colonic stents decreases the morbidity and mortality, as well as cost, in comparison with surgical intervention for acute colonic obstruction. Management with colonic stents can also rule out proximal synchronous lesions after initial decompression prior to definitive surgery. Benign conditions may also be treated with stents. A multidisciplinary approach for the use of colonic stents during assessment and management of acute colonic obstruction is necessary in order to achieve a satisfactory outcome, whether that be better quality of life or improved survival.
传统上，结肠支架用于结直肠癌的治疗，无论是姑息治疗还是作为手术的桥梁。最近，结肠支架也被提倡作为良性狭窄治疗的一部分。全球有多种结肠支架，其中 4 种是美国制造的。这些支架分为覆盖型和未覆盖型，具有相似的临床应用。这些不同支架的技术和临床成功率以及并发症发生率相似，主要包括梗阻和迁移。部署系统利用荧光透视术、内窥镜检查或两者结合。最近，出现了一种可“经内镜”（TTS）部署的支架，使手术更快。然而，这一进展并没有排除使用荧光透视术的必要性，特别是在近端狭窄直接可视化缺失的情况下。与急性结肠梗阻的手术干预相比，结肠支架在结直肠癌治疗中的应用经验不断增加，降低了发病率和死亡率以及成本。在进行明确手术之前，结肠支架的初始减压也可以排除近端同步病变。支架也可用于良性疾病的治疗。在评估和处理急性结肠梗阻时，需要采用多学科方法来使用结肠支架，以实现满意的结果，无论是提高生活质量还是改善生存率。
