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结肠癌支架在肺癌转移导致的结肠梗阻中的应用。

Usefulness of a Colonic Stent for Colonic Obstruction Caused by Lung Cancer Metastasis.

机构信息

Department of Surgery, Tsuboi Hospital.

Department of Gastroenterology, Tsuboi Hospital.

出版信息

J Nippon Med Sch. 2021 Dec 29;88(6):556-560. doi: 10.1272/jnms.JNMS.2021_88-514. Epub 2020 Nov 30.

Abstract

The gastrointestinal tract is not a common site for metastasis from lung cancer, and colonic metastases are especially rare. Although surgical intervention can improve colonic obstruction, perioperative mortality is high in patients with advanced malignancy, and these patients experience a significant deterioration in quality of life postoperatively. This report describes an uncommon case of colonic metastasis from non-small cell lung cancer (NSCLC), in which colonic obstruction was improved with a self-expanding metallic stent. A 62-year-old man was admitted to our hospital for progressively worsening abdominal pain. He had been treated with immunotherapy and chemotherapy after being diagnosed with NSCLC (T4N2M1) 1.5 years earlier. Enhanced computed tomography showed intestinal obstruction and a mass in the colon at the hepatic flexure. Histopathological analysis of a biopsy specimen confirmed NSCLC metastasis. Considering his general condition, endoscopic stenting was chosen as an urgent decompression procedure. He was discharged 45 days after stenting and was able to resume immunotherapy. Emergency stenting could be offered at experienced centers when operative intervention is not part of the treatment plan, as it is safe and improves the efficiency of care along with the quality of life.

摘要

胃肠道不是肺癌转移的常见部位,而结肠转移则更为罕见。虽然手术干预可以改善结肠梗阻,但晚期恶性肿瘤患者的围手术期死亡率较高,并且这些患者术后生活质量显著恶化。本报告描述了一例非小细胞肺癌(NSCLC)结肠转移的罕见病例,其中结肠梗阻通过自膨式金属支架得到改善。一名 62 岁男性因进行性加重的腹痛而被收入我院。他在 1.5 年前被诊断为 NSCLC(T4N2M1)后接受了免疫治疗和化疗。增强 CT 显示肠梗阻和升结肠处有一个肿块。活检标本的组织病理学分析证实为 NSCLC 转移。考虑到他的一般情况,选择内镜下支架置入术作为紧急减压手术。他在支架置入后 45 天出院,能够恢复免疫治疗。在经验丰富的中心,当手术干预不是治疗计划的一部分时,可以提供紧急支架置入术,因为它是安全的,可以提高护理效率和生活质量。

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