Lee Kee Myung, Lim Sun Gyo, Shin Sung Jae, Kim Jin Hong, Kang Dae Hwan, Kim Jae Keun, Hwang Jae Chul, Kwon Chang-Il, Cheong Jae Yeon, Yoo Byung Moo
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea; Korean Society of Gastrointestinal Stent Research Group, Seoul, South Korea.
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Gastrointest Endosc. 2013 Dec;78(6):930-933. doi: 10.1016/j.gie.2013.08.018.
Self-expandable metal stents are an alternative to preoperative and palliative colostomy for patients with malignant colorectal obstruction. However, self-expandable metal stent placement is considered unsuitable or contraindicated for patients with malignant lower rectal obstruction within 5 cm of the anal verge because the exposed stent portion can irritate the distal rectum and cause anal pain and a foreign body sensation.
To describe our experience with 6 patients with malignant lower rectal obstruction who underwent stent insertion with a proximal releasing delivery system (PRDS).
Prospective clinical series outcome study.
A tertiary-care referral university hospital.
This study involved all patients at our center who had a malignant lower rectal obstruction within 5 cm of the anal verge caused by rectal cancer and bladder cancer.
Uncovered stent with the PRDS with endoscopic and fluoroscopic guidance.
Technical and clinical success rate, adverse event rate, and stent migration rate.
All stents were placed at the expected location. Technical and clinical success rates were 100%. Two patients reported anal pain, which was controlled with analgesics. One case of tumor ingrowth occurred after 5 months and was treated with reinsertion of a stent with the PRDS. After stent insertion, the patients received chemotherapy, chemoradiotherapy, or conservative care.
Small number of patients and no comparison group. Further prospective, randomized, controlled trials are needed.
Uncovered stent insertion with the PRDS is a feasible, safe, and effective treatment for the patient with malignant lower rectal obstruction within 5 cm from the anal verge.
对于患有恶性大肠梗阻的患者，自膨式金属支架是术前和姑息性结肠造口术的一种替代方案。然而，对于距肛缘5厘米以内的恶性低位直肠梗阻患者，自膨式金属支架置入被认为不适用或为禁忌，因为暴露的支架部分会刺激直肠远端并引起肛门疼痛和异物感。
描述我们对6例接受近端释放输送系统（PRDS）支架置入术的恶性低位直肠梗阻患者的经验。
前瞻性临床系列结局研究。
一家三级医疗转诊大学医院。
本研究纳入了我们中心所有因直肠癌和膀胱癌导致距肛缘5厘米以内恶性低位直肠梗阻的患者。
在胃镜和荧光镜引导下使用PRDS置入裸支架。
技术成功率、临床成功率、不良事件发生率和支架移位率。
所有支架均放置在预期位置。技术成功率和临床成功率均为100%。两名患者报告有肛门疼痛，通过使用镇痛药得到控制。5个月后发生1例肿瘤长入，通过再次使用PRDS置入支架进行治疗。支架置入后，患者接受了化疗、放化疗或保守治疗。
患者数量少且无对照组。需要进一步进行前瞻性、随机、对照试验。
使用PRDS置入裸支架对于距肛缘5厘米以内的恶性低位直肠梗阻患者是一种可行、安全且有效的治疗方法。
