Elzaki Amin
Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, Saudi Arabia.
Asian J Surg. 2023 Jan;46(1):412-416. doi: 10.1016/j.asjsur.2022.05.003. Epub 2022 May 15.
To assess the clinical outcomes of self-expandable metal stent (SEMS) placement for patients with colorectal obstruction.
A total of 61 patients underwent SEMS placement using computerized tomography (CT) to confirm malignancy of intrinsic origin and evaluate the exact location, notch, and extent of the disruptive laceration.
The overall technical success rate and clinical success rate of SEMS placement using the radiological method were 59 (96.7%) and 57 (93.4%), respectively. The technical success rate and clinical success rate of SEMS placement in the palliative and bridge to elective surgery (BTS) groups were 35 (97.2%), 24 (96.0%), 33 (91.7%), and 24 (96.0%). The median cumulative primary stent patency duration and patients' survival of SEMS placement was 123 days (95% CI, 65-123 days), and 133 days (95% CI, 72-133 days). The median cumulative primary stent patency duration and patient survival did not differ significantly between the palliative group 119 days; (95% CI, 59-119 days), 128 days; (95% CI, 71-128 days), and the BTS group 120 days; (95% CI, 68-120 days; p = 0.362), 130 days; (95% CI, 78-130 days); p = 0.412).
The colorectal obstruction had convoluted with curved angulation and located mainly at the rectum, sigmoid, descending colon, and the radiologic method of SEMS placement has more efficacious with a high technical and clinical success rate. However, SEMS placement was highly technical, and clinical success with median stent patency and patient survival did not differ significantly between the palliative group and the BTS group.
评估自膨式金属支架(SEMS)置入术治疗大肠梗阻患者的临床疗效。
共有61例患者接受了SEMS置入术,采用计算机断层扫描(CT)确认原发性恶性肿瘤,并评估撕裂伤的确切位置、切口和范围。
采用放射学方法置入SEMS的总体技术成功率和临床成功率分别为59例(96.7%)和57例(93.4%)。姑息治疗组和择期手术过渡(BTS)组中SEMS置入术的技术成功率和临床成功率分别为35例(97.2%)、24例(96.0%)、33例(91.7%)和24例(96.0%)。SEMS置入术的中位累积原发性支架通畅持续时间和患者生存期分别为123天(95%CI,65 - 123天)和133天(95%CI,72 - 133天)。姑息治疗组中位累积原发性支架通畅持续时间为119天(95%CI,59 - 119天),患者生存期为128天(95%CI,71 - 128天);BTS组中位累积原发性支架通畅持续时间为120天(95%CI,68 - 120天;p = 0.362),患者生存期为130天(95%CI,78 - 130天;p = 0.412),两组之间无显著差异。
大肠梗阻呈弯曲成角状,主要位于直肠、乙状结肠、降结肠,SEMS置入术的放射学方法疗效更佳,技术成功率和临床成功率高。然而,SEMS置入术技术要求高,姑息治疗组和BTS组之间的临床成功率、中位支架通畅时间和患者生存期无显著差异。