van den Berg M W, Ledeboer M, Dijkgraaf M G W, Fockens P, ter Borg F, van Hooft J E
Department of Gastroenterology & Hepatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands,
Surg Endosc. 2015 Jun;29(6):1580-5. doi: 10.1007/s00464-014-3845-7. Epub 2014 Oct 8.
Endoscopic placement of self-expanding-metal-stents (SEMS) is widely performed as palliative treatment for acute malignant colonic obstruction. There is ongoing debate regarding risks and benefits associated with SEMS placement. This study aimed to evaluate long-term outcomes of palliative SEMS placement in patients presenting with acute malignant colonic obstruction.
A prospectively collected patient cohort (2005-2013) from a general teaching hospital was used. In this hospital, all consecutive patients presenting with acute malignant large bowel obstruction are treated with endoscopic SEMS placement. Only colon cancer patients who underwent palliative SEMS placement were selected.
In total, 48 patients were included. The technical and short-term clinical success rates were 91 % (44/48) and 85 % (36/48), respectively. SEMS-related mortality occurred in 6/48 patients (13 %) (early n = 4, late n = 2) and was caused by SEMS-related perforation in all cases. The SEMS-related morbidity rate was 38 % (18/48) (early n = 7, late n = 11). Endoscopic re-intervention was performed 14 times and 13 patients eventually underwent surgical treatment during follow-up. The stoma-formation rate was 15 % (7/48). Long-term clinical success was 48 % (23/48). The estimated stent patency rate (95 % confidence interval) was 69 % (52-79) at 1 month, 54 % (37-66) at 6 months and 50 % (33-62) at 12 months.
Palliative SEMS placement provides rapid relief of obstruction and avoids a stoma in most patients with acute colonic obstruction caused by incurable or inoperable colon cancer. However, these benefits should be weighed against mortality and morbidity related to SEMS placement.
自膨式金属支架（SEMS）的内镜置入术作为急性恶性结肠梗阻的姑息治疗方法被广泛应用。关于SEMS置入术的风险和益处一直存在争议。本研究旨在评估急性恶性结肠梗阻患者姑息性SEMS置入术的长期疗效。
使用一家综合教学医院前瞻性收集的患者队列（2005 - 2013年）。在这家医院，所有连续出现急性恶性大肠梗阻的患者均接受内镜SEMS置入术治疗。仅选择接受姑息性SEMS置入术的结肠癌患者。
共纳入48例患者。技术成功率和短期临床成功率分别为91%（44/48）和85%（36/48）。48例患者中有6例（13%）发生SEMS相关死亡（早期4例，晚期2例），所有病例均由SEMS相关穿孔导致。SEMS相关发病率为38%（18/48）（早期7例，晚期11例）。随访期间进行了14次内镜再次干预，13例患者最终接受了手术治疗。造口形成率为15%（7/48）。长期临床成功率为48%（23/48）。估计支架通畅率（95%置信区间）在1个月时为69%（52 - 79），6个月时为54%（37 - 66），12个月时为50%（33 - 62）。
姑息性SEMS置入术能迅速缓解梗阻，在大多数由无法治愈或无法手术的结肠癌引起的急性结肠梗阻患者中可避免造口。然而，这些益处应与SEMS置入术相关的死亡率和发病率相权衡。
