Department of Gastroenterology and Hepatology, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Deventer, The Netherlands.
Br J Surg. 2014 Jun;101(7):867-73. doi: 10.1002/bjs.9521. Epub 2014 Apr 16.
Endoscopic self-expanding metal stent (SEMS) placement as a bridge to surgery is an option for acute malignant colonic obstruction. There is ongoing debate regarding the superiority and oncological safety of SEMS placement compared with emergency surgery. This retrospective study aimed to compare outcomes of these treatment approaches.
Patients were identified from cohorts treated between 2005 and 2012 in two teaching hospitals, of which one used emergency surgery only in patients with large bowel obstruction, whereas the other attempted SEMS placement. Only patients treated with curative intent were included.
The study included 59 patients in whom SEMS placement was attempted and 51 who underwent surgery alone. The successful primary anastomosis rate was higher in the SEMS group than in the surgery-alone group among patients with left-sided obstruction (30 of 43 versus 10 of 34 respectively; P = 0.001), whereas stoma formation was less common (11 of 43 versus 23 of 34; P < 0.001). Such differences were not apparent in patients with right-sided obstruction. Secondary stoma rates were comparable between treatment approaches (left-sided: 11 of 43 versus 13 of 34, P = 0.322; right-sided: 1 of 16 versus 1 of 17, P = 1.000). There were no significant differences in morbidity, mortality, recurrence or survival.
Endoscopic SEMS placement increased the primary anastomosis rate in patients with left-sided large bowel obstruction.
内镜下自膨式金属支架（SEMS）置入术作为手术的桥梁，是治疗急性恶性结肠梗阻的一种选择。目前仍在争论 SEMS 置入术与急诊手术相比的优势和肿瘤安全性。本回顾性研究旨在比较这两种治疗方法的结果。
本研究从 2005 年至 2012 年在两家教学医院接受治疗的队列中确定了患者，其中一家医院仅对大肠梗阻患者采用急诊手术，而另一家医院则尝试 SEMS 置入术。仅纳入接受根治性治疗的患者。
本研究共纳入 59 例尝试 SEMS 置入术的患者和 51 例单独接受手术的患者。在左侧梗阻患者中，SEMS 组的初次吻合成功率高于手术组（分别为 30/43 与 10/34；P = 0.001），而造口形成的比例较低（分别为 11/43 与 23/34；P < 0.001）。右侧梗阻患者中则无明显差异。两种治疗方法的二级造口率相似（左侧：11/43 与 13/34，P = 0.322；右侧：1/16 与 1/17，P = 1.000）。在发病率、死亡率、复发率或生存率方面，两种治疗方法无显著差异。
内镜下 SEMS 置入术可提高左侧大肠梗阻患者的初次吻合成功率。
