Mabardy Allan, Miller Peter, Goldstein Rachel, Coury Joseph, Hackford Alan, Dao Haisar
Department of Surgery, Saint Elizabeth's Medical Center, Tufts University School of Medicine, Brighton, Massachusetts.
JSLS. 2015 Jan-Mar;19(1):e2014.00254. doi: 10.4293/JSLS.2014.00254.
Colonic stenting has been used in the setting of malignant obstruction to avoid an emergent colectomy. We sought to determine whether preoperative placement of a colonic stent decreases morbidity and the rate of colostomy formation.
Cases of obstructing sigmoid, rectosigmoid, and rectal cancer from January 1, 2010, to December 31, 2011, were identified in the Nationwide Inpatient Sample (NIS) database. All patients were treated at hospitals in the United States, and the database generated national estimates. Postoperative complications, mortality, and the rate of colostomy formation were analyzed.
Of the estimated 7891 patients who presented with obstructing sigmoid, rectosigmoid, or rectal cancer necessitating intervention, 12.1% (n = 956) underwent placement of a colonic stent, and the remainder underwent surgery without stent placement. Of the patients who underwent stenting, 19.9% went on to have colon resection or stoma creation during the same admission. Patients who underwent preoperative colonic stent placement had a lower rate of total postoperative complications (10.5% vs 21.7%; P < .01). There was no significant difference in mortality (4.7% vs 4.2%; P = .69). The rate of colostomy formation was more than 2-fold higher in patients who did not undergo preoperative stenting (42.5% vs 19.5%; P < .01). Preoperative stenting was associated with increased use of laparoscopy (32.6% vs 9.7%; P < .01).
Our study characterizes the national incidence of preoperative placement of a colonic stent in the setting of malignant obstruction. Preoperative stent placement is associated with lower postoperative complications and a lower rate of colostomy formation. The results support the hypothesis that stenting as a bridge to surgery may benefit patients by converting an emergent surgery into an elective one.
结肠支架置入术已被用于恶性肠梗阻的治疗，以避免急诊结肠切除术。我们试图确定术前放置结肠支架是否能降低发病率和结肠造口术的形成率。
在全国住院患者样本（NIS）数据库中识别出2010年1月1日至2011年12月31日期间患有乙状结肠、直肠乙状结肠和直肠癌梗阻的病例。所有患者均在美国医院接受治疗，该数据库生成全国性估计数据。分析术后并发症、死亡率和结肠造口术的形成率。
在估计的7891例因乙状结肠、直肠乙状结肠或直肠癌梗阻而需要干预的患者中，12.1%（n = 956）接受了结肠支架置入术，其余患者未放置支架直接接受手术。在接受支架置入术的患者中，19.9%在同一住院期间接受了结肠切除术或造口术。术前放置结肠支架的患者术后总并发症发生率较低（10.5%对21.7%；P < 0.01）。死亡率无显著差异（4.7%对4.2%；P = 0.69）。未接受术前支架置入术的患者结肠造口术的形成率高出2倍多（42.5%对19.5%；P < 0.01）。术前支架置入术与腹腔镜检查的使用增加相关（32.6%对9.7%；P < 0.01）。
我们的研究描述了在恶性梗阻情况下术前放置结肠支架的全国发病率。术前支架置入术与较低的术后并发症和较低的结肠造口术形成率相关。结果支持以下假设，即作为手术桥梁的支架置入术可通过将急诊手术转变为择期手术而使患者受益。
