Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
Gut Liver. 2011 Jun;5(2):165-70. doi: 10.5009/gnl.2011.5.2.165. Epub 2011 Jun 24.
BACKGROUND/AIMS: There are limited data regarding the clinical outcomes of self-expandable metal stents in the treatment of proximal colon obstruction. We compared the clinical outcomes of stent placement in patients with malignant proximal to distal colon obstructions.
We reviewed medical records from 37 consecutive patients from three institutions (19 men; mean age, 72 years) who underwent endoscopic stent placement at a malignant obstruction of the proximal colon. We also examined the records from 99 patients (50 men; mean age, 65 years) who underwent endoscopic stent placement for a distal colon obstruction. Technical success, clinical improvements, complications and stent patency were compared between treatments.
The technical success rate tended to be lower in stents inserted to treat proximal colon obstructions than in those used to treat distal colon obstructions (86% vs 97%, p=0.06). Clinical improvement was achieved in 78% of patients (29/37) with proximal colonic stenting and in 91% of patients (90/99) with distal colonic stenting (p=0.08). Complications (24% vs 27%), stent migration (8% vs 8%) and stent reocclusion rates (11% vs 17%) did not differ significantly between groups. Two cases of bowel perforation related to stenting (5%) occurred in patients with proximal colonic stenting.
The technical success and clinical improvement associated with self-expandable metal stents used to treat proximal colon obstruction tend to be lower than cases of distal colon obstruction. Technical failure is an important cause of poor clinical improvement in patients with proximal colon stenting. Complication rates and stent patency appear to be similar in both groups.
背景/目的：关于自膨式金属支架治疗近端结肠梗阻的临床结果数据有限。我们比较了支架置入治疗近端和远端结肠癌梗阻的临床结果。
我们回顾了来自三个机构的 37 例连续患者（19 名男性；平均年龄 72 岁）的病历，这些患者在近端结肠恶性梗阻时进行了内镜下支架置入。我们还检查了 99 例（50 名男性；平均年龄 65 岁）因远端结肠梗阻接受内镜下支架置入的患者的记录。比较了两种治疗方法的技术成功率、临床改善、并发症和支架通畅率。
治疗近端结肠梗阻的支架置入技术成功率倾向于低于治疗远端结肠梗阻的支架置入（86% vs 97%，p=0.06）。近端结肠支架置入的 78%（29/37）患者和远端结肠支架置入的 91%（90/99）患者获得临床改善（p=0.08）。并发症（24% vs 27%）、支架迁移（8% vs 8%）和支架再闭塞率（11% vs 17%）在两组之间无显著差异。近端结肠支架置入的 2 例（5%）患者发生与支架置入相关的肠穿孔。
自膨式金属支架治疗近端结肠梗阻的技术成功率和临床改善率倾向于低于治疗远端结肠梗阻的情况。技术失败是近端结肠支架置入患者临床改善不良的一个重要原因。两组并发症发生率和支架通畅率相似。
