Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Int J Colorectal Dis. 2021 Apr;36(4):689-700. doi: 10.1007/s00384-021-03834-9. Epub 2021 Jan 25.
After almost three decades since the first description of colonic stents, the controversies of its safe application continue to impede the readiness of adoption by clinicians for malignant left bowel obstruction. This review seeks to address some of the controversial aspects of stenting and its impact on surgical and oncological outcomes.
Medline, Embase, and CNKI were searched for articles employing SEMS for left colonic obstruction. Outcomes analyzed include success rates, complications, and long-term survival. Pooled risk ratio (RR) and 95% confidence interval (CI) were estimated.
36 studies were included with 2002 patients across seven randomized controlled trials and 29 observational studies. High technical (92%) and clinical (82%) success rates, and low rates of complications, including perforation (5%), were found. Those with > 8% perforation rates had poorer technical success rates than those with ≤ 8%, but there were no significant differences in 90-day in-hospital mortality and three and 5-year overall and disease-free survival. A significant increase was found in technical (RR = 1.094; CI, 1.041-1.149; p < 0.001) and clinical (RR = 1.158; CI, 1.064-1.259; p = 0.001) success rates when the duration between stenting and surgery was ≥ 2 weeks compared to < 2 weeks, but there were no significant differences in perforation rates, 90-day in-hospital mortality, and long-term survival.
Colonic stenting is safe and effective with high success rates and low complication rates. However, outcomes of higher perforation rates and optimal timing from stent till surgery remain unclear, with only a few studies reporting on these outcomes, leaving areas for future research.
自首次描述结肠支架以来，近三十年来，其安全应用的争议仍阻碍了临床医生对恶性左肠阻塞采用该方法的积极性。本综述旨在探讨支架应用的一些有争议的方面及其对手术和肿瘤学结果的影响。
在 Medline、Embase 和中国知网（CNKI）中检索使用 SEMS 治疗左结肠梗阻的文章。分析的结果包括成功率、并发症和长期生存率。采用合并风险比（RR）和 95%置信区间（CI）进行估计。
纳入了 36 项研究，共纳入了 2002 例患者，包括 7 项随机对照试验和 29 项观察性研究。发现支架技术（92%）和临床（82%）成功率高，并发症发生率低，包括穿孔（5%）。穿孔发生率>8%的患者技术成功率低于穿孔发生率≤8%的患者，但 90 天院内死亡率、3 年和 5 年总生存率和无病生存率无显著差异。支架置入和手术之间的时间间隔≥2 周与<2 周相比，技术（RR=1.094；CI，1.041-1.149；p<0.001）和临床（RR=1.158；CI，1.064-1.259；p=0.001）成功率显著提高，但穿孔率、90 天院内死亡率和长期生存率无显著差异。
结肠支架置入安全有效，成功率高，并发症发生率低。然而，支架置入后至手术的最佳时间、穿孔发生率较高的结果仍不明确，仅有少数研究报告了这些结果，未来仍有研究空间。
