Pal Atanu, Saada Janak, Kapur Sandeep, Tighe Richard, Stearns Adam, Hernon James, Speakman Chris
Sir Thomas Browne Academic Colorectal Unit, Division of General Surgery, Norfolk and Norwich University Hospital, Norwich, UK.
Cambridge Colorectal Unit, Department of General Surgery, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
Ann Coloproctol. 2021 Apr;37(2):85-89. doi: 10.3393/ac.2019.06.12.1. Epub 2020 Mar 16.
Malignant large bowel obstruction is a surgical emergency that requires urgent decompression. Stents are increasingly being used, though reported outcomes are variable. We describe our multidisciplinary experience in using stents to manage malignant large bowel obstruction.
All patients undergoing colorectal stent insertion for acute large bowel obstruction in a teaching hospital were included. Outcomes, complications, and length of stay (LOS) were recorded.
Over a 7-year period, 73 procedures were performed on 67 patients (37 male, mean age of 76 years). Interventional radiology was involved in all cases. Endoscopic guidance was required in 24 cases (32.9%). In 18 patients (26.9%), treatment intent was to bridge to elective surgery; 16 had successful stent placement; all had subsequent curative resection (laparoscopic resection, 8 of 18; primary anastomosis, 14 of 18). Overall LOS, including both index admission and elective admission, was 16.4 days. Treatment intent was palliative in 49 patients (73.1%). In this group, stents were successfully placed in 41 of 49 (83.7%). Complication rate within 30 days was 20%, including perforation (2 patients), per rectal bleeding (2), stent migration (1), and stent passage (5). Nineteen patients (38.8%) required subsequent stoma formation (6, during same admission; 13, during subsequent admission). Overall LOS was 16.9 days.
In our experience colorectal stents can be used effectively to manage malignant large bowel obstruction, with only selective endoscopic input. As a bridge to surgery, most patients can avoid emergency surgery and have a primary anastomosis. In the palliative setting, the complication rate is acceptable and two-thirds avoid a permanent stoma.
恶性大肠梗阻是一种需要紧急减压的外科急症。虽然报道的支架治疗结果不一，但支架在该疾病中的应用越来越广泛。我们描述了我们在使用支架治疗恶性大肠梗阻方面的多学科经验。
纳入在一家教学医院因急性大肠梗阻接受结直肠支架置入术的所有患者。记录治疗结果、并发症和住院时间（LOS）。
在7年期间，对67例患者（37例男性，平均年龄76岁）进行了73例手术。所有病例均有介入放射科参与。24例（32.9%）需要内镜引导。18例患者（26.9%）的治疗目的是过渡到择期手术；16例成功置入支架；所有患者随后均进行了根治性切除（18例中的8例为腹腔镜切除；18例中的14例为一期吻合）。包括首次入院和择期入院在内的总住院时间为16.4天。49例患者（73.1%）的治疗目的是姑息性治疗。在该组中，49例中的41例（83.7%）成功置入支架。30天内的并发症发生率为20%，包括穿孔（2例患者）、直肠出血（2例）、支架移位（1例）和支架通过困难（5例）。19例患者（38.8%）需要随后造口（6例在同一住院期间；13例在随后的住院期间）。总住院时间为16.9天。
根据我们的经验，结直肠支架可有效用于治疗恶性大肠梗阻，仅需选择性的内镜辅助。作为手术的过渡，大多数患者可避免急诊手术并进行一期吻合。在姑息性治疗中，并发症发生率可接受，三分之二的患者可避免永久性造口。
