Department of Gastroenterology, The First Hospital of China Medical University, Shenyang, China.
Department of Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China.
Ann Palliat Med. 2020 Jul;9(4):1614-1621. doi: 10.21037/apm-19-458. Epub 2020 Jul 14.
The self-expanding metal stent (SEMS) or transanal drainage tube (TDT) methods can be used as a palliative treatment before tumor resection surgery. Studies systematically comparing the efficacy and characteristics between SEMS with TDT are limited, especially in a large-scale Chinese population. This retrospective study aimed to compare the outcomes of these treatment approaches.
This was a retrospective comparative study of patients with an acute malignant left colorectal obstruction who underwent a preoperative decompressive procedure with SEMS or TDT intervention between December 2014 and October 2017. The indicators after endoscopic treatment and tumor resection surgery between the SEMS and TDT groups were compared.
206 patients underwent endoscopic intervention to relieve obstruction, including 139 patients treated with SEMS and 67 patients treated with TDT. The technical success rates of the SEMS group and TDT group were 97.1% and 95.6%, respectively, and the rates of obstruction relief were 92.8% and 86.6%, respectively. TDT was more easily translocated than SEMS (P=0.02), and there was no significant difference in the incidence of other complications. However, SEMS had a lower complication rate than TDT (P=0.02), and could alleviate the obstruction faster (P<0.01). There were 72 patients and 44 patients who took resection surgery in the SEMS group and TDT group, respectively. The direct anastomosis rates were 73.6% and 63.6% (P=0.26), respectively, and only 1 case in the TDT group had anastomotic leakage. The surgery time of the SEMS group was significantly shorter than that of the TDT group (P=0.01). There was no significant difference between the 2 groups in terms of postoperative hospital stay (P=1.00) or total treatment costs for patients undergoing surgery (P=0.26).
Both TDT and SEMS could effectively relieve acute left malignant colorectal obstruction with safe and reliable results, and they could both reduce the stomas rate compared with traditional surgery. SEMS could alleviate obstruction faster than TDT and had fewer complications.
自膨式金属支架（SEMS）或经肛引流管（TDT）方法可作为肿瘤切除术前的姑息治疗。系统比较 SEMS 和 TDT 疗效和特点的研究有限，特别是在大规模的中国人群中。本回顾性研究旨在比较这些治疗方法的结果。
这是一项回顾性比较研究，纳入 2014 年 12 月至 2017 年 10 月间接受术前减压内镜治疗的急性左结直肠恶性梗阻患者，比较 SEMS 和 TDT 组内镜治疗和肿瘤切除术后的指标。
206 例患者接受内镜干预以缓解梗阻，其中 139 例接受 SEMS 治疗，67 例接受 TDT 治疗。SEMS 组和 TDT 组的技术成功率分别为 97.1%和 95.6%，梗阻缓解率分别为 92.8%和 86.6%。TDT 比 SEMS 更易移位（P=0.02），其他并发症发生率无显著差异。然而，SEMS 的并发症发生率低于 TDT（P=0.02），并且能够更快地缓解梗阻（P<0.01）。SEMS 组和 TDT 组分别有 72 例和 44 例患者接受了切除术，直接吻合率分别为 73.6%和 63.6%（P=0.26），仅 TDT 组 1 例发生吻合口漏。SEMS 组的手术时间明显短于 TDT 组（P=0.01）。两组患者的术后住院时间（P=1.00）或手术患者的总治疗费用（P=0.26）均无显著差异。
TDT 和 SEMS 均可有效缓解急性左结直肠恶性梗阻，结果安全可靠，与传统手术相比，均可降低造口率。SEMS 可较 TDT 更快缓解梗阻，且并发症更少。
