Giannessi S, Paroli G M, Fedi M, Riccadonna S, Gori A, Lombardi M, Colugnat D, Da Massa Carrara P, De Carli V
Unità Operativa di Chirurgia Generale Azienda USL 3, Ospedale "del Ceppo Pistoia, Italia -
Minerva Chir. 2013 Jun;68(3):299-306.
Self expandable metal stent (SEMS) can be used to relieve malignant colorectal obstruction. The stent serves as a palliative measure for high-risk patients or those with unresectable tumor on subsequent workup. For low-risk patients with resectable disease, SEMS serves as a safe and effective bridge to subsequent laparoscopic surgery.
From August 2009 to April 2012 we have treated with SEMS 39 patients, 20 of whom with palliative purpose; 19 patients are treated with SEMS for bridge to surgery, out of these patients, 8 were women, 11 men with median age of 61.4 years (range 36-81 years). Technical success, defined as a successful stent placement and deployment in the stricture site, was achieved for 39/40 patients (97.5%). The average duration of the procedure was about 60 minutes (range 15-120).
Clinical success was achieved for all the 39 patients, 19 of these could be subjected to bowel preparation and colon resection after 25 days from the positioning. No colostomy was performed. Among patients undergoing the procedure, perforation occurred in 1 case.
In summary, the colonic stent placement is a complex method that needs qualified medical-nursing team, able to solve any difficult situation, such as the severe, irregular and distal obstruction. SEMS positioning guarantees a high percentage of clinical and technical success; however it is necessary to pay attention to the risk of complications like bowel perforation.
自膨式金属支架（SEMS）可用于缓解恶性大肠梗阻。该支架可作为高危患者或后续检查发现有不可切除肿瘤患者的姑息性治疗措施。对于患有可切除疾病的低风险患者，SEMS是后续腹腔镜手术安全有效的桥梁。
从2009年8月至2012年4月，我们用SEMS治疗了39例患者，其中20例用于姑息治疗目的；19例患者接受SEMS作为手术桥梁治疗，在这些患者中，8例为女性，11例为男性，中位年龄为61.4岁（范围36 - 81岁）。技术成功定义为在狭窄部位成功放置和展开支架，39/40例患者（97.5%）实现了技术成功。手术平均持续时间约60分钟（范围15 - 120分钟）。
39例患者均取得临床成功，其中19例在定位后25天可进行肠道准备和结肠切除。未进行结肠造口术。在接受该手术的患者中，有1例发生穿孔。
总之，结肠支架置入是一种复杂的方法，需要合格的医护团队，能够解决任何困难情况，如严重、不规则和远端梗阻。SEMS定位保证了较高的临床和技术成功率；然而，有必要注意诸如肠穿孔等并发症的风险。
