自膨式金属支架作为急性左侧恶性结肠梗阻手术桥梁的再评估：六年经验
Reevaluation of Self-Expanding Metal Stents as a Bridge to Surgery for Acute Left-Sided Malignant Colonic Obstruction: Six Years Experience.
作者信息
Ribeiro Iolanda, Pinho Rolando, Leite Mariana, Proença Luísa, Silva Joana, Ponte Ana, Rodrigues Jaime, Maciel-Barbosa Jorge, Carvalho João
机构信息
Gastroenterology and Hepatology Department, Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova de Gaia, Portugal.
Surgery Department, Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova de Gaia, Portugal.
出版信息
GE Port J Gastroenterol. 2016 Mar 11;23(2):76-83. doi: 10.1016/j.jpge.2016.01.003. eCollection 2016 Mar-Apr.
INTRODUCTION
Self-expanding metal stents (SEMS) as a bridge to surgery have been used as an alternative for acute malignant left-sided colonic obstruction. However, the benefits are uncertain. The European Society of Gastrointestinal Endoscopy no longer recommends their use in patients with low surgical risk because of the risk of tumor recurrence.
METHODS
Patients admitted for acute malignant left-sided colonic obstruction who underwent SEMS as a bridge to elective surgery or urgent surgery were retrospectively evaluated. Postoperative morbidity/mortality, stent complications and survival were recorded. Our aim was to compare the outcome between preoperative SEMS and direct emergent surgery in acute left-sided malignant colonic obstruction.
RESULTS
42 patients were included (SEMS group: 27 and surgery group: 15). There were no differences between groups in relation to age, ASA classification and tumor stage. The technical success of SEMS was 88.9% and the clinical success was 85.2%. There were three SEMS related perforations. In the surgery group, the stoma rate was higher (86.7% vs 25.9%, < 0.001) and there was a trend for a lower length of hospital stay (18.9 days vs 26.3 days, = 0.051). SEMS verses surgery group: There were no differences in the rate of temporary stoma (57.1% vs 61.5%, = 0.84), definitive stoma (42.8% vs 38.5%, = 0.84), success of primary anastomosis (86.7% vs 66.7%, = 0.22) and Clavien-Dindo classification (≥III: 36% vs 58.2% = 0.24). Overall survival at 1/5 years was identical in the two groups 100%/56% in the SEMS group vs 93%/43% in the surgery group, = 0.14), as well as tumor recurrence at 3/5 years (24%/50% vs 20%/36% respectively, = 0.68).
CONCLUSIONS
SEMS are associated with a lower overall stoma rate and a higher primary anastomosis rate. However, there are no differences in complications, overall survival and recurrence between the groups.
引言
自膨式金属支架（SEMS）作为手术过渡手段，已被用作急性恶性左侧结肠梗阻的一种替代方法。然而，其益处尚不确定。由于存在肿瘤复发风险，欧洲胃肠内镜学会不再推荐在手术风险低的患者中使用。
方法
对因急性恶性左侧结肠梗阻入院并接受SEMS作为择期手术或急诊手术过渡手段的患者进行回顾性评估。记录术后发病率/死亡率、支架并发症及生存率。我们的目的是比较急性左侧恶性结肠梗阻患者术前SEMS与直接急诊手术的结果。
结果
纳入42例患者（SEMS组：27例；手术组：15例）。两组在年龄、美国麻醉医师协会（ASA）分级和肿瘤分期方面无差异。SEMS的技术成功率为88.9%，临床成功率为85.2%。发生3例与SEMS相关的穿孔。手术组的造口率更高（86.7%对25.9%，<0.001），且住院时间有缩短趋势（18.9天对26.3天，=0.051）。SEMS组与手术组比较：临时造口率（57.1%对61.5%，=0.84）、永久性造口率（42.8%对38.5%，=0.84）、一期吻合成功率（86.7%对66.7%，=0.22）及Clavien-Dindo分级（≥Ⅲ级：36%对58.2%，=0.24）均无差异。两组1年/5年总生存率相同（SEMS组为100%/56%，手术组为93%/43%，=0.14），3年/5年肿瘤复发率也相同（分别为24%/50%对20%/36%，=0.68）。
结论
SEMS与总体造口率较低及一期吻合率较高相关。然而，两组在并发症、总生存率和复发率方面无差异。
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