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体能状态是肠外恶性肿瘤所致恶性狭窄患者结肠支架置入术后病情改善的预测因素。

Performance Status Is a Predictive Factor of Improvement after Colonic Stenting in Patients with Malignant Stenosis due to Extraparenteral Malignant Tumors.

作者信息

Shiratori Yasutoshi, Ishii Naoki, Ikeya Takashi, Takagi Koichi, Nakamura Kenji, Fukuda Katsuyuki

机构信息

Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.

Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan.

出版信息

Gastroenterol Res Pract. 2020 Jun 27;2020:5931341. doi: 10.1155/2020/5931341. eCollection 2020.

Abstract

Endoscopic stenting with self-expandable metallic stents is widely accepted for the treatment of malignant colorectal obstruction. Generally, stenting is performed as a bridge-to-surgery for primary colorectal cancer (CRC). Furthermore, palliative colonic stenting is performed for extraparenteral malignant tumors (EPMTs). However, predictive factors for improving clinical outcomes after colonic stenting for EPMTs remain unclear. This study is aimed at evaluating patients with EPMTs who underwent colonic stenting and investigating factors influencing clinical improvement after the stenting procedure. Twenty-one patients with colorectal obstruction by EPMTs were treated using self-expandable metallic stents over a period of 8 years. We divided the enrolled patients into the clinically improved and nonimproved groups after colonic stenting. Variables, including age; sex; type of primary cancer; serum albumin level; location of the obstruction; stent type, length, and diameter; prior chemotherapy treatment; ascites; Eastern Cooperative Oncology Group performance status (PS); technical and clinical success rates; stent-related adverse events; and mortality rates, were evaluated. Technical failure was not observed in all cases. Clinical success, defined as the passage of stool and improvement in the colorectal obstruction scoring system (CROSS) without adverse events, was observed in the 14 patients. Univariate analyses revealed no significant differences in factors other than PS before stenting ( = 0.04) between the improved and nonimproved groups. Colonic stenting for EPMTs was effective. PS may be an independent risk factor of clinical outcomes after stenting.

摘要

自膨式金属支架内镜下支架置入术在治疗恶性大肠梗阻方面已被广泛接受。一般来说,支架置入术作为原发性结直肠癌(CRC)手术前的桥梁治疗。此外,姑息性结肠支架置入术用于治疗肠外恶性肿瘤(EPMT)。然而,EPMT结肠支架置入术后改善临床结局的预测因素仍不明确。本研究旨在评估接受结肠支架置入术的EPMT患者,并调查支架置入术后影响临床改善的因素。在8年的时间里,对21例因EPMT导致大肠梗阻的患者使用自膨式金属支架进行了治疗。我们将入组患者在结肠支架置入术后分为临床改善组和未改善组。评估了包括年龄、性别、原发癌类型、血清白蛋白水平、梗阻部位、支架类型、长度和直径、既往化疗、腹水、东部肿瘤协作组体能状态(PS)、技术成功率和临床成功率、支架相关不良事件以及死亡率等变量。所有病例均未观察到技术失败。14例患者观察到临床成功,定义为大便通过且大肠梗阻评分系统(CROSS)改善且无不良事件。单因素分析显示,改善组和未改善组之间除支架置入术前的PS(P = 0.04)外,其他因素无显著差异。EPMT的结肠支架置入术是有效的。PS可能是支架置入术后临床结局的独立危险因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bbee/7336230/1295c8f41d36/GRP2020-5931341.001.jpg

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