Oakville Trafalgar Memorial Hospital and the Oakville Endoscopy Centre, Oakville, Ont.
Can J Surg. 2011 Aug;54(4):282-5. doi: 10.1503/cjs.015510.
Self-expandable metal stents (SEMS) can provide temporary relief of acute large bowel obstructions. Placement of SEMS creates the opportunity for semi-elective 1-stage surgical resections, use of possible adjuvant therapy or palliative relief of malignant obstructions. Our aim was to assess the likelihood of success and possible complication rates of SEMS insertion in a community hospital setting in patients presenting with large bowel obstructions.
We conducted a retrospective chart review at a single community-based hospital. This review addressed the technical success in deployment of the SEMS, clinical success defined by relief of the obstruction, procedure-related complications, surgical interventions and completion of adjuvant therapy for patients with large bowel obstructions.
In a 34-month period, 16 patients underwent 16 SEMS procedures. The average age of patients was 69.4 years and 7 (44%) were women. Thirteen patients had intrinsic colorectal cancers, 1 had an extracolonic lesion (ovarian cancer) and 2 had strictures due to diverticular disease. Technical success occurred in all 16 patients, but only 15 (94%) had clinical success. No procedure-related deaths (defined as death within 7 days) occurred. Palliative stenting occurred in 5 patients (31%). Eleven patients (69%) eventually had surgery. Stenting allowed a window for neoadjuvant therapy in 4 patients. Ten of 11 patients (91%) had a 1-stage procedure. One patient had a cecal perforation presenting 2 days after SEMS. This patient received a defunctioning ileostomy.
In appropriate patients with large bowel obstructions, SEMS proced ures can be safely and effectively performed in a community-based setting.
自膨式金属支架（SEMS）可提供急性大肠梗阻的临时缓解。SEMS 的放置为半择期 1 期手术切除、辅助治疗或恶性梗阻姑息治疗创造了机会。我们的目的是评估在出现大肠梗阻的社区医院环境中，SEMS 插入的成功率和可能的并发症发生率。
我们在一家社区医院进行了回顾性图表审查。该审查涉及 SEMS 部署的技术成功率、以梗阻缓解定义的临床成功率、与手术相关的并发症、手术干预和大肠梗阻患者辅助治疗的完成情况。
在 34 个月的时间里，16 名患者接受了 16 次 SEMS 手术。患者的平均年龄为 69.4 岁，其中 7 名（44%）为女性。13 名患者患有原发性结直肠癌，1 名患者患有结外病变（卵巢癌），2 名患者因憩室疾病导致狭窄。16 名患者均成功进行了技术操作，但只有 15 名（94%）患者临床成功。无与手术相关的死亡（定义为 7 天内死亡）发生。5 名患者（31%）进行了姑息性支架置入。11 名患者（69%）最终接受了手术。支架置入为 4 名患者提供了新辅助治疗的窗口。11 名患者中的 10 名（91%）进行了 1 期手术。1 名患者在 SEMS 后 2 天出现盲肠穿孔，该患者接受了保护性回肠造口术。
在适当的大肠梗阻患者中，SEMS 程序可以在社区环境中安全有效地进行。
