Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620 Seoul, Korea.
AJR Am J Roentgenol. 2020 Jul;215(1):248-253. doi: 10.2214/AJR.19.22247. Epub 2020 Apr 22.
The purpose of this study is to compare the clinical outcomes of stent placement for the palliative treatment of colorectal obstruction in patients with extracolonic malignancy (ECM) versus those with primary colorectal cancer (CRC) and to identify the risk factors for stent failure. Between January 2005 and December 2017, a total of 85 patients underwent stent placement for the palliative treatment of inoperable malignant colorectal obstructions caused by ECM ( = 56) or CRC ( = 29). Technical and clinical success, reintervention rates, and stent patency were compared between the two groups. Predictive factors associated with stent failure were identified. Stent placement was technically successful in 54 patients with ECM (96.4%) and 27 patients with CRC (93.1%) ( = 0.60). The proportion of patients with ECM who required reintervention was greater than that of patients with CRC (20.4% vs 3.7%, respectively; 0.04); however, they had a marginally lower clinical success rate (88.9% vs 100.0%, respectively; = 0.07). The 6- and 12-month stent patency rates were 64.2% and 22.0%, respectively, in patients with ECM and 68.4% and 31.3%, respectively, in patients with CRC ( = 0.89). Long obstructions (hazard ratio, 1.40) and multiple obstructions (hazard ratio, 4.03) were independent factors associated with stent failure. Stent placement for the palliative treatment of colorectal obstruction is less effective and more frequently requires reintervention in patients with ECM than in patients with CRC. Long obstructions and multiple obstructions were associated with stent failure.
本研究旨在比较腔内支架置入术治疗合并结外恶性肿瘤（extracolonic malignancy，ECM）和原发性结直肠癌（colorectal cancer，CRC）的结直肠恶性梗阻患者的临床结局，并确定支架失败的危险因素。2005 年 1 月至 2017 年 12 月，共 85 例 ECM（n=56）或 CRC（n=29）所致不可切除的结直肠恶性梗阻患者接受了支架置入姑息治疗。比较两组患者的技术成功率、临床成功率、再干预率和支架通畅率。确定与支架失败相关的预测因素。56 例 ECM 患者和 27 例 CRC 患者支架置入技术均成功（96.4%和 93.1%，=0.60）。需要再次干预的 ECM 患者比例高于 CRC 患者（20.4% vs 3.7%， 0.04），但临床成功率略低（88.9% vs 100.0%，=0.07）。ECM 患者 6 个月和 12 个月的支架通畅率分别为 64.2%和 22.0%，CRC 患者分别为 68.4%和 31.3%（=0.89）。长段梗阻（危险比，1.40）和多处梗阻（危险比，4.03）是支架失败的独立相关因素。支架置入术治疗 ECM 所致结直肠恶性梗阻的效果较差，且需要再次干预的频率高于 CRC。长段梗阻和多处梗阻与支架失败相关。
