Department of Gastroenterology, Pulido Valente Hospital, Faculty of Medical Sciences, Lisbon, Portugal.
Rev Esp Enferm Dig. 2012 Aug;104(8):418-25. doi: 10.4321/s1130-01082012000800005.
self-expanding metal stents are currently being used as a definitive palliative treatment for malignant colorectal obstruction in patients with incurable disease. Few studies have followed large numbers of patients from stent placement until death, and those few have reported conflicting results in the long-term clinical outcome data.
this study evaluated the clinical effectiveness of stent placement for malignant colorectal obstruction throughout the patients lives and related factors affecting stent patency, clinical success and complications.
this was a multicentre, retrospective study of 89 consecutive patients who had undergone attempted expandable stent placement for symptomatic malignant colorectal obstruction during a 10-year period. Data were collected to analyse the sustained relief of obstructive symptoms throughout the patients lives, as well as the technical success, immediate clinical success, stent patency, complications, reinterventions, survival, prognostic factors associated with stent patency and long-term clinical efficacy and risk factors for complications.
technical and immediate clinical success were achieved in 95.5% and 91.0% of patients, respectively. A total of 68 out of 89 patients (76.4%) maintained relief of obstruction from stent implantation until death without reintervention. Twenty patients (22.5%) had complications including perforation (n = 4; 4.5%), stent obstruction (n = 8; 9.0%), migration (n = 5; 5.6%) and haemorrhage (n = 3; 3.4%). Stent-related mortality was seen in 1 patient (1.1%). The estimated median survival and estimated mean stent patency were 87.0 and 322.7 days, respectively. In total, 12 of the initial 89 patients (13.5%) needed a colostomy for long-term relief of the obstructive symptoms. Univariate and multivariate analysis detected no significant prognostic factors associated with stent patency, long term clinical efficacy and risk factors for complications; however, the multivariate logistic model revealed a non-significant trend by which the use of chemotherapy was a risk factor for migration (OR = 11.89; p = 0.06).
for palliation of incurable malignant colorectal obstruction, expandable stents can provide sustained relief of obstruction in approximately 75% of patients. The procedure is associated with acceptable morbidity, need for reintervention and minimal mortality.
自膨式金属支架目前被用作无法治愈疾病患者恶性结直肠梗阻的姑息性治疗方法。很少有研究对大量接受支架置入的患者进行随访，直到死亡，而这些研究在长期临床结果数据方面报告的结果存在矛盾。
本研究评估了支架置入治疗不可治愈的恶性结直肠梗阻的临床效果，以及影响支架通畅性、临床成功和并发症的相关因素。
这是一项多中心、回顾性研究，共纳入 89 例连续接受可扩张支架置入术治疗症状性恶性结直肠梗阻的患者，研究时间为 10 年。收集数据以分析患者一生中持续性缓解梗阻症状的情况，以及技术成功率、即刻临床成功率、支架通畅性、并发症、再干预、生存、与支架通畅性相关的预后因素以及并发症的危险因素。
技术成功率和即刻临床成功率分别为 95.5%和 91.0%。89 例患者中，68 例（76.4%）在未再干预的情况下，从支架植入中持续缓解梗阻至死亡。20 例（22.5%）发生并发症，包括穿孔（n=4；4.5%）、支架阻塞（n=8；9.0%）、迁移（n=5；5.6%）和出血（n=3；3.4%）。1 例（1.1%）患者因支架相关死亡。估计中位生存期和平均支架通畅时间分别为 87.0 和 322.7 天。总共有 12 例（13.5%）初始 89 例患者需要造口术以长期缓解梗阻症状。单因素和多因素分析均未发现与支架通畅性、长期临床疗效和并发症危险因素相关的显著预后因素；然而，多因素逻辑模型显示，化疗的使用是迁移的危险因素（OR=11.89；p=0.06）。
对于无法治愈的恶性结直肠梗阻的姑息治疗，可扩张支架可使约 75%的患者持续性缓解梗阻。该手术相关的发病率、需要再干预和死亡率可接受。
