I Clinica Chirurgica Pietro Valdoni, University of Rome La Sapienza, Rome, Italy.
Am J Surg. 2012 Sep;204(3):321-6. doi: 10.1016/j.amjsurg.2011.11.013. Epub 2012 May 9.
Survival in patients with stage IV unresectable rectosigmoid cancer is significantly reduced, and when patients are seen with symptoms of obstruction, it is advisable to perform a diverting colostomy before acute obstruction occurs. The aim of this study was to compare the results of endoscopic stent placement with diverting proximal colostomy in patients with stage IV rectosigmoid cancer and symptoms of chronic subacute obstruction.
In a prospective randomized trial, 22 patients with stage IV unresectable rectosigmoid cancer and symptoms of chronic subacute obstruction were randomized to either endoscopic placement of an expandable stent or diverting proximal colostomy. Patients were followed until death.
There was no case of mortality or major postoperative complications. Oral feeding and bowel function were restored within 24 hours after endoscopic stent placement and within 72 hours after diverting colostomy. Hospital stays were shorter (mean, 2.6 days) in patients with endoscopic stent placement than in those with diverting stomas (mean, 8.1 days) (P < .05). Mean long-term survival was 297 days (range, 125-612 days) in patients who had stents and 280 days (range, 135-591 days) in patients with stomas (P = NS). No case of mortality during follow-up was related to the procedures. All patients with stomas found them quite unacceptable. The same feelings were present in family members. None of the patients with stents or their family members found any inconvenience about the procedure.
Endoscopic expandable stent placement offers a valid solution in patients with stage IV unresectable cancer and symptoms of chronic subacute obstruction, with shorter hospital stays. The procedure is much better accepted, psychologically and practically, by patients and their family members.
IV 期不可切除的直肠乙状结肠癌患者的生存率显著降低，当患者出现梗阻症状时，在急性梗阻发生前，建议行预防性结肠转流术。本研究旨在比较内镜支架置入术与 IV 期直肠乙状结肠癌伴慢性亚急性梗阻症状患者行预防性结肠转流术的结果。
前瞻性随机试验中，22 例 IV 期不可切除的直肠乙状结肠癌伴慢性亚急性梗阻症状的患者被随机分为内镜下扩张支架置入组或预防性结肠转流术组。患者随访至死亡。
无死亡或严重术后并发症发生。内镜支架置入术后 24 小时内和预防性结肠转流术后 72 小时内恢复经口进食和肠道功能。内镜支架置入组的住院时间更短（平均 2.6 天），而预防性结肠转流术组（平均 8.1 天）（P<0.05）。支架组的中位生存期为 297 天（范围 125-612 天），转流组为 280 天（范围 135-591 天）（P=NS）。随访期间无死亡与操作相关。所有带造口的患者都认为造口术完全不可接受。患者家属也有同样的感受。带支架的患者及其家属均认为操作无任何不便。
内镜下扩张支架置入术为 IV 期不可切除肿瘤伴慢性亚急性梗阻症状的患者提供了有效的解决方案，可缩短住院时间。患者及其家属在心理和实际方面更能接受该操作。
