Salamone Giuseppe, Falco Nicolò, Atzeni Jenny, Tutino Roberta, Licari Leo, Gulotta Gaspare
Ann Ital Chir. 2014 Nov-Dec;85(6):556-62.
This retrospective study aims to evaluate clinical and cost effectiveness of colonic stenting as a bridge to surgery and as a palliative treatment in acutely obstructed left-sided colon cancer.
Onehundred fortyfour patients were collected between 2006 and 2012, with acute left-sided malignant colonic obstruction with no evidence of peritonitis: 96 patients underwent surgical treatment, 48 underwent decompressive stenting. For the stenting we used self-expandable metallic stent in nitinol.
Patients who had successful colonic stenting were 40, 8 underwent elective surgery within 10 days, 32 decompression stenting had only palliative intent. in 8/48 patients subjected to stenting decompression there was a technical failure (16%) and underwent emergency surgery. 40 patients had follow-up. at the time of observation 36 patients had a functioning stent, within 10 days 8 underwent elective definitive colonic resection with primary anastomosis trought videolaparoscopic thecnical, 4 (10%) had major complications and underwent emergency surgery. no patient of 40 in the stenting group required defunctioning stomas compared to 38 of 96 in emergency surgery group. we also compared the cost of decompressive stenting and emergency surgery treatment in acutely obstructed left-sided colon cancer referring to average cost of drg (1 and 2 code t-student test). the comparison of the average costs between decompressive stenting and emergency surgery was performed in the group of patients underwent palliative treatment separately from ones underwent radical treatment.
Colonic stenting followed by elective surgery may be safer and cost-effective, comparing to emergency surgery for left-sided malignant colonic obstruction.
Bowel obstruction, Colonic cancer, Colonic stenting.
本回顾性研究旨在评估结肠支架置入术作为急性梗阻性左侧结肠癌手术桥梁及姑息治疗的临床效果和成本效益。
收集2006年至2012年间144例急性左侧恶性结肠梗阻且无腹膜炎证据的患者：96例行手术治疗，48例行减压支架置入术。支架置入术采用镍钛诺自膨式金属支架。
成功进行结肠支架置入术的患者有40例，其中8例在10天内接受择期手术，32例减压支架置入术仅为姑息性目的。在48例行支架减压术的患者中，8例（16%）出现技术失败并接受急诊手术。40例患者进行了随访。观察时，36例患者的支架功能良好，10天内8例通过视频腹腔镜技术接受择期确定性结肠切除并一期吻合，4例（10%）出现严重并发症并接受急诊手术。支架置入组40例患者均无需行造瘘术，而急诊手术组96例中有38例需要。我们还比较了急性梗阻性左侧结肠癌减压支架置入术和急诊手术治疗的成本，参考了疾病诊断相关分组（DRG）的平均成本（t检验，代码1和2）。在接受姑息治疗的患者组和接受根治性治疗的患者组中分别比较了减压支架置入术和急诊手术的平均成本。
与左侧恶性结肠梗阻的急诊手术相比，结肠支架置入术后续择期手术可能更安全且具有成本效益。
肠梗阻；结肠癌；结肠支架置入术
