Department Pietro Valdoni-Policlinico Umberto I, University of Rome La Sapienza, Viale del Policlinico, 00167, Rome, Italy.
World J Surg. 2012 Dec;36(12):2931-6. doi: 10.1007/s00268-012-1767-x.
The aim of the present study was to analyze the results of our experience with elective placement of self-expandable metallic stents (SEMS) in patients with stage IV obstructing colorectal cancer. A systematic review of the literature was also carried out to analyze the factors influencing the results of SEMS placement and to determine if there has been any improvement in the more recent period.
The results of a personal series of 100 patients were analyzed. There was no case of mortality or major morbidity. The systematic review included 27 articles published from April 2007 to December 2011.
In our experience the technical success rate was 96% and the clinical success rate was 92%. During the follow-up period a repeat colonoscopy was needed in 31% of the patients for recurrent symptoms of obstruction due to fecal impaction (19%), tumor growth (8%), or stent dislodgment (4%). Review of the literature showed similar results, with a significant improvement in the reports of the last 6 years; procedures performed on an emergency basis had poorer results.
Self-expandable metallic stent placement offers a valid alternative to surgery in patients with obstructing stage IV colorectal cancer, but careful follow-up is required.
本研究旨在分析我们在伴有 IV 期梗阻的结直肠癌患者中选择性放置自膨式金属支架（SEMS）的经验结果。还进行了系统的文献回顾，以分析影响 SEMS 放置结果的因素，并确定在最近的时期是否有所改善。
分析了 100 例患者的个人系列结果。无死亡或严重并发症。系统回顾包括 2007 年 4 月至 2011 年 12 月期间发表的 27 篇文章。
在我们的经验中，技术成功率为 96%，临床成功率为 92%。在随访期间，由于粪便嵌塞（19%）、肿瘤生长（8%）或支架移位（4%）导致梗阻症状复发，31%的患者需要重复进行结肠镜检查。文献回顾显示了类似的结果，最近 6 年的报告显示有显著改善；紧急进行的手术结果较差。
自膨式金属支架置入术为伴有 IV 期结直肠癌梗阻的患者提供了一种有效的手术替代方法，但需要仔细随访。
