Endoscopy Unit, Bispebjerg Hospital, Bispebjerg Bakke 23, Entrance 7B, 2400 Copenhagen NV, Denmark.
Gastroenterol Res Pract. 2012;2012:296347. doi: 10.1155/2012/296347. Epub 2012 Jun 11.
Background. Self-expanding metal stents can alleviate malignant colonic obstruction in incurable patients and avoid palliative stoma surgery. Objective. Evaluate stent effectiveness and safety on palliation of patients with malignant colorectal strictures. Design. Two prospective, one Spanish and one global, multicenter studies. Settings. 39 centers (22 academic, 17 community hospitals) from 13 countries. Patients. A total of 257 patients were enrolled, and 255 patients were treated with a WallFlex uncovered enteral colonic stent. Follow-up was up to 12 months or until death or retreatment. Interventions(s). Self-expanding metal stent placement. Main Outcome Measures. Procedural success, clinical success, and safety. Results. Procedural success was 98.4% (251). Clinical success rates were 87.8% at 30 days, 89.7% at 3 months, 92.8% at 6 months, and 96% at 12 months. Overall perforation rate was 5.1%. Overall migration rate was 5.5%. Overall death rate during follow-up was 48.6% (124), with 67.7% of deaths related to the patient's colorectal cancer, unrelated in 32.3%. Only 2 deaths were related to the stent or procedure. Limitations. No control group. Conclusions. The primary palliative option for patients with malignant colonic obstruction should be self-expanding metal stent placement due to high rates of technical success and efficacy in symptom palliation and few complications.
自膨式金属支架可缓解无法治愈患者的恶性结肠梗阻，并避免姑息性造口手术。目的：评估支架在缓解恶性结直肠狭窄患者中的疗效和安全性。设计：两项前瞻性研究，一项为西班牙研究，另一项为全球多中心研究。地点：来自 13 个国家的 39 个中心（22 家学术机构，17 家社区医院）。患者：共纳入 257 例患者，255 例患者接受了 WallFlex uncovered 肠内结肠支架治疗。随访时间最长为 12 个月或直至死亡或再次治疗。干预措施：自膨式金属支架置入术。主要观察指标：操作成功率、临床成功率和安全性。结果：操作成功率为 98.4%（251 例）。30 天时的临床成功率为 87.8%，3 个月时为 89.7%，6 个月时为 92.8%，12 个月时为 96%。总体穿孔率为 5.1%。总体迁移率为 5.5%。随访期间的总死亡率为 48.6%（124 例），其中 67.7%的死亡与患者的结直肠癌有关，32.3%与结直肠癌无关。仅有 2 例死亡与支架或手术有关。局限性：无对照组。结论：对于恶性结肠梗阻患者，自膨式金属支架置入术应作为主要的姑息治疗选择，因为其技术成功率高，症状缓解效果好，并发症少。
