Cases-Baldó Maria José, García-Marín José Andrés, Aguayo-Albasini José Luis, Pellicer-Franco Enrique, Soria-Aledo Víctor, Pérez-Cuadrado Enrique
Servicio de Cirugía General y Aparato Digestivo, Hospital Morales Meseguer Murcia, Murcia, Spain.
Cir Cir. 2012 Nov-Dec;80(6):523-7.
in emergency surgery, colorectal mortality is very high compared with elective surgery. An alternative is placement of endoscopic stents to correct the bowel obstruction and then allow elective surgery. Moreover, it is possible to use stents in the palliative treatment of patients at high surgical risk or with unresecable tumors. The aim of this study is to evaluate the rates of technical and clinical success and complications of colorectal stent placement over the past 5 years.
retrospective study of 33 patients in which stents were placed since 2006 to 2011. Variables were analyzed: 1) the indication (palliation or "bridge to surgery"), 2) rates of technical success and clinical success, and 3) complications (perforation, migration, bleeding, and reocclusion).
in 24 patients the prosthesis was placed as a palliative treatment (72.7%) and in 9 cases as a "bridge to surgery". The technical success rate was 87.87% and 82.14% clinical success. There were five cases of bowel perforation with high pneumoperitoneum and a case of microperforation (18.1%). Five patients had reocclusion (17.2%); there were 3 and 4 with bleeding and migration. Three patients died within 24 hours after endoscopic treatment. In 9 cases of "bridge to surgery," technical success was 100% and 77% clinical success. One patient required emergency surgery due to migration of the prosthesis and reocclusion and another colonic perforation.
endoscopic treatment is a good option as a transitional step to elective surgery or palliative treatment. But serious complications such as perforation or reocclusion should be considered.
在急诊手术中,结直肠手术的死亡率与择期手术相比非常高。一种替代方法是放置内镜支架以纠正肠梗阻,然后进行择期手术。此外,对于手术风险高或肿瘤无法切除的患者,也可以使用支架进行姑息治疗。本研究的目的是评估过去5年中结直肠支架置入术的技术成功率、临床成功率及并发症发生率。
回顾性研究2006年至2011年期间置入支架的33例患者。分析以下变量:1)适应证(姑息治疗或“手术桥梁”);2)技术成功率和临床成功率;3)并发症(穿孔、移位、出血和再梗阻)。
24例患者将假体作为姑息治疗放置(72.7%),9例作为“手术桥梁”。技术成功率为87.87%,临床成功率为82.14%。有5例肠穿孔伴高气腹和1例微穿孔(18.1%)。5例患者出现再梗阻(17.2%);3例和4例分别出现出血和移位。3例患者在内镜治疗后24小时内死亡。在9例“手术桥梁”病例中,技术成功率为100%,临床成功率为77%。1例患者因假体移位和再梗阻以及另1例结肠穿孔而需要急诊手术。
内镜治疗作为择期手术或姑息治疗的过渡步骤是一个不错的选择。但应考虑穿孔或再梗阻等严重并发症。