1Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea 2Department of Surgery, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Dis Colon Rectum. 2014 Jun;57(6):694-9. doi: 10.1097/DCR.0000000000000061.
Although the initial clinical efficacy of self-expandable metal stents is acceptable, doubt still remains about long-term clinical outcomes and complications.
The aim of this study was to evaluate the stoma formation rate and risk factors for complications after successful stenting in patients with obstructive metastatic colorectal cancer.
This was a tertiary-care center retrospective study.
From January 2000 to December 2010, 130 patients with unresectable obstructive colorectal cancer received successful self-expandable metal stent placement. Among them, 14 patients received primary colectomy after successful stenting.
Self-expandable metal stent placement and primary colectomy were performed.
The stoma formation rate and complications were measured.
In patients with successful stenting, stoma formation rates at 1 and 2 years were 15.6% (95% CI, 8.74-22.4) and 24.4% (95% CI, 13.8-35.0), and the median patency duration was 157 days (range, 2-1590 days). However, long-term complications occurred in 58 patients (44.6%), including reobstruction (32.6%), stent migration (10.3%), and perforation (7.8%), and a large number of reinterventions (45.7%) and hospitalizations (37/9%) were needed to manage complications. In multivariate analysis, primary colectomy after successful endoscopic stenting was a negative predictive factor for reobstruction (OR, 0.12; 95% CI, 0.02-0.99; p = 0.04).
This was a retrospective, single-center study.
To reduce stent-related late complications, primary colectomy after successful endoscopic stenting could be a therapeutic option in patients who have unresectable colorectal cancer with obstruction, especially in those who expect long-term survival.
尽管自膨式金属支架的初始临床疗效可以接受，但对于成功支架置入后患者的长期临床结局和并发症仍存在疑问。
本研究旨在评估在治疗梗阻性转移性结直肠癌患者时，成功支架置入后吻合口形成率和并发症的危险因素。
这是一项三级医疗中心的回顾性研究。
2000 年 1 月至 2010 年 12 月，130 例无法切除的梗阻性结直肠癌患者接受了自膨式金属支架成功置入。其中，14 例患者在成功支架置入后接受了原发结肠切除术。
自膨式金属支架置入和原发结肠切除术。
吻合口形成率和并发症。
在成功支架置入的患者中，1 年和 2 年的吻合口形成率分别为 15.6%（95%CI，8.74-22.4）和 24.4%（95%CI，13.8-35.0），中位通畅时间为 157 天（范围，2-1590 天）。然而，58 例患者（44.6%）发生了长期并发症，包括再梗阻（32.6%）、支架移位（10.3%）和穿孔（7.8%），需要进行大量的再次介入治疗（45.7%）和住院治疗（37/9%）来处理并发症。多因素分析显示，成功内镜支架置入后行原发结肠切除术是再梗阻的负预测因素（OR，0.12；95%CI，0.02-0.99；p=0.04）。
这是一项回顾性、单中心研究。
为了减少支架相关的晚期并发症，对于无法切除的结直肠癌合并梗阻的患者，成功内镜支架置入后行原发结肠切除术可能是一种治疗选择，尤其是那些预计长期生存的患者。
Zotero 插件