Lujan Henry J, Barbosa Guilherme, Zeichen Marianna S, Mata Wilmer N, Maciel Victor, Plasencia Gustavo, Hartmann Rene F, Viamonte Manuel, Fogel Roberto
Jackson South Community Hospital, Miami, FL, USA.
JSLS. 2013 Apr-Jun;17(2):204-11. doi: 10.4293/108680813X13654754534990.
Acute colorectal obstruction is a potentially life-threatening emergency that requires immediate surgical treatment. Emergency procedures had an associated mortality rate of 10% to 30%. This encouraged development of other options, most notably self-expanding metallic stents. The primary endpoint of this study to is to report our group's experience.
We performed a retrospective review of 37 patients who underwent self-expanding metallic stent placement for colorectal obstruction between July 2000 and May 2012. Data collected were age, comorbidities, diagnosis, intent of intervention (palliative vs bridge to surgery), complications, and follow-up.
The study comprised 21 men (56.76%) and 16 women (43.24%), with a mean age of 67 years. The intent of the procedure was definitive treatment in 22 patients (59.46%) and bridge to surgery in 15 (40.54%). The highest technical success rate was at the rectosigmoid junction (100%). The causes of technical failure were inability of the guidewire to traverse the stricture and bowel perforation related to stenting. The mean follow-up period was 9.67 months. Pain and constipation were the most common postprocedure complications.
The use of a self-expanding metallic stent has been shown to be effective for palliation of malignant obstruction. It is associated with a lower incidence of intensive care unit admission, shorter hospital stay, lower stoma rate, and earlier chemotherapy administration. Laparoscopic or robotic surgery can then be performed in an elective setting on a prepared bowel. Therefore the patient benefits from advantages of the combination of 2 minimally invasive procedures in a nonemergent situation. Further large-scale prospective studies are necessary.
急性结直肠梗阻是一种可能危及生命的急症，需要立即进行手术治疗。急诊手术的相关死亡率为10%至30%。这促使人们开发其他治疗方法，最显著的是自膨式金属支架。本研究的主要目的是报告我们团队的经验。
我们对2000年7月至2012年5月期间接受自膨式金属支架置入术治疗结直肠梗阻的37例患者进行了回顾性研究。收集的数据包括年龄、合并症、诊断、干预目的（姑息治疗与手术过渡）、并发症和随访情况。
该研究包括21名男性（56.76%）和16名女性（43.24%），平均年龄为67岁。手术目的为确定性治疗的患者有22例（59.46%），手术过渡的患者有15例（40.54%）。技术成功率最高的部位是直肠乙状结肠交界处（100%）。技术失败的原因是导丝无法穿过狭窄部位以及与支架置入相关的肠穿孔。平均随访期为9.67个月。疼痛和便秘是术后最常见的并发症。
自膨式金属支架已被证明对缓解恶性梗阻有效。它与重症监护病房入住率较低、住院时间较短、造口率较低以及更早进行化疗相关。然后可以在择期情况下对准备好的肠道进行腹腔镜或机器人手术。因此，患者在非紧急情况下受益于两种微创手术相结合的优势。有必要进行进一步的大规模前瞻性研究。
