Zeng Zhaofei, Liu Yang, Wu Ketong, Li Dan, Lai Haiyang, Zhang Bo
Interventional Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Dig Dis Sci. 2023 Mar;68(3):939-947. doi: 10.1007/s10620-022-07557-x. Epub 2022 Jun 2.
To investigate long-term outcomes after SEMS insertion in patients with malignant colorectal obstruction and to identify the risk factors for complications.
The data of 119 patients with malignant colorectal obstruction who received SEMS insertion between March 2014 and February 2020 were retrospectively analyzed. Patients were divided into two groups according to the intent of treatment, i.e., stenting as "bridge to surgery" (surgical group) and stenting for palliation (palliative group). Technical and clinical success rates and incidence of complications were compared between the two groups.
The overall technical and clinical success rates were 97.5% and 96.6%, respectively. The technical and clinical success rates and complication rate were comparable between the two groups. In the palliative group, the mean stent patency time was 230 days. Patency rates were not significantly different between primary CRC and recurrent CRC. Incidence of complications was higher in the palliative group than in the surgical group. In multivariate analysis, chemotherapy before stent implantation may increase the risk of stent-related complications, whereas chemotherapy after stent implantation did not. Additionally, the factors independently associated with complications were female sex and preoperative chemotherapy.
SEMS under fluoroscopic guidance is a safe and effective treatment for malignant colorectal obstruction. For patients with resectable CRC, stent placement can serve as a bridge to elective surgery. It is worth noting that adjuvant chemotherapy between SEMS and surgery did not increase the complications. For patients with recurrent CRC, stent placement can relieve symptoms, alleviate pain, and improve quality of life.
探讨自膨式金属支架（SEMS）置入术治疗恶性大肠梗阻的远期疗效，并确定并发症的危险因素。
回顾性分析2014年3月至2020年2月期间119例行SEMS置入术的恶性大肠梗阻患者的数据。根据治疗目的将患者分为两组，即作为“手术桥梁”的支架置入术（手术组）和姑息性支架置入术（姑息组）。比较两组的技术成功率、临床成功率及并发症发生率。
总体技术成功率和临床成功率分别为97.5%和96.6%。两组的技术成功率、临床成功率及并发症发生率相当。在姑息组，支架平均通畅时间为230天。原发性结直肠癌和复发性结直肠癌的通畅率无显著差异。姑息组的并发症发生率高于手术组。多因素分析显示，支架植入前化疗可能增加支架相关并发症的风险，而支架植入后化疗则不会。此外，与并发症独立相关的因素为女性和术前化疗。
透视引导下的SEMS是治疗恶性大肠梗阻的一种安全有效的方法。对于可切除的结直肠癌患者，支架置入可作为择期手术的桥梁。值得注意的是，SEMS与手术之间的辅助化疗并未增加并发症。对于复发性结直肠癌患者，支架置入可缓解症状、减轻疼痛并提高生活质量。
