Jung Won Beom, Shin Jin Yong, Park Jong Kwon
Department of Surgery, Haeundae Paik Hospital, College of Medicine, University of Inje, Busan, Republic of Korea.
Medicine (Baltimore). 2020 Apr;99(14):e19557. doi: 10.1097/MD.0000000000019557.
The self-expanding metallic stent (SEMS) has been comprehensively investigated as a bridge to surgery. SEMS enables the control of acute colonic obstruction. However, comparison between SEMS and diverting colostomy as another bridge procedure was still challenging issue. Thus, the aim of this study was to compare these 2 procedures.In this retrospective cohort study, patients who received diverting colostomy and SEMS for acute left colonic obstruction between February 2016 and August 2018 were included. They were classified into the colostomy group (n = 27), including 5 patients who had SEMS failure previously, and the SEMS group (n = 23). The clinicopathologic parameters, pathologic results, and short-term outcomes were compared.No significant differences were found in clinicopathologic characteristics and complication rates between the 2 groups. After the bridge procedures, the SEMS group showed a higher rate of laparoscopic colonic resection than the colostomy group (100% vs 76%, P = .023). The colostomy group showed a higher rate of rectal cancer (24.0% vs 9.1%, P = .019) and later recovery of flatus (3 vs 2 days, P = .011) than the SEMS group. Additionally, the length of resected colon was longer in the colostomy group than in the SEMS group (33.9 vs 23.4 cm, P = .007).Although SEMS might permit higher laparoscopic resection rates and faster recovery of bowel habits than diverting colostomy, SEMS showed meaningful failure rate including migration and perforation. In addition, diverting colostomy showed acceptable complication rates and feasible performance. An individualized approach is necessary considering the advantages and disadvantages of both procedures.
自膨式金属支架（SEMS）已被全面研究作为手术的桥梁。SEMS能够控制急性结肠梗阻。然而，将SEMS与转流性结肠造口术作为另一种桥梁手术进行比较仍是一个具有挑战性的问题。因此，本研究的目的是比较这两种手术。在这项回顾性队列研究中，纳入了2016年2月至2018年8月期间因急性左半结肠梗阻接受转流性结肠造口术和SEMS的患者。他们被分为结肠造口术组（n = 27），其中包括5例先前SEMS失败的患者，以及SEMS组（n = 23）。比较了临床病理参数、病理结果和短期结局。两组之间在临床病理特征和并发症发生率方面未发现显著差异。在进行桥梁手术后，SEMS组的腹腔镜结肠切除术发生率高于结肠造口术组（100%对76%，P = 0.023）。结肠造口术组的直肠癌发生率（24.0%对9.1%，P = 0.019）和肠胀气恢复较晚（3天对2天，P = 0.011）高于SEMS组。此外，结肠造口术组切除结肠的长度比SEMS组长（33.9对23.4 cm，P = 0.007）。虽然SEMS可能比转流性结肠造口术允许更高的腹腔镜切除率和更快的肠道习惯恢复，但SEMS显示出包括移位和穿孔在内的有意义的失败率。此外，转流性结肠造口术显示出可接受的并发症发生率和可行的操作。考虑到两种手术的优缺点，采取个体化方法是必要的。
