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在梗阻性结直肠癌治疗中,结肠支架置入作为手术的桥梁。

Colon stenting as a bridge to surgery in obstructive colorectal cancer management.

作者信息

Kim Dong Hyun, Lee Han Hee

机构信息

Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.

Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

出版信息

Clin Endosc. 2024 Jul;57(4):424-433. doi: 10.5946/ce.2023.138. Epub 2024 Mar 8.

Abstract

Colonic stent placement is a commonly used bridging strategy for surgery in patients with obstructive colorectal cancer. The procedure involves the placement of a self-expandable metallic stent (SEMS) across the obstructive lesion to restore intestinal patency and alleviate the symptoms of obstruction. By allowing patients to receive surgery in a planned and staged manner with time for preoperative optimization and bowel preparation, stent placement may reduce the need for emergency surgery, which is associated with higher complication rates and poorer outcomes. This review focuses on the role of colon stenting as a bridge to surgery in the management of obstructive colorectal cancer. SEMS as a bridge to surgery for left-sided colon cancer has been demonstrated to be particularly useful; however, further research is needed for its application in cases of right-sided colon cancer. Colon stent placement also has limitations and potential complications including stent migration, re-obstruction, and perforation. However, the timing of curative surgery after SEMS placement remains inconclusive. Considering the literature to date, performing surgery at an interval of approximately 2 weeks is considered appropriate. Therefore, colonic stent placement may be an effective strategy as a bridge to surgery in patients with obstructive colorectal cancer.

摘要

结肠支架置入术是梗阻性结直肠癌患者手术常用的过渡策略。该手术包括在梗阻性病变处放置自膨式金属支架(SEMS),以恢复肠道通畅并缓解梗阻症状。通过让患者有时间进行术前优化和肠道准备,从而能够以计划好的分期方式接受手术,支架置入术可减少急诊手术的需求,而急诊手术与更高的并发症发生率和更差的预后相关。本综述聚焦于结肠支架置入术在梗阻性结直肠癌治疗中作为手术过渡手段的作用。SEMS作为左侧结肠癌手术的过渡手段已被证明特别有用;然而,其在右侧结肠癌病例中的应用仍需进一步研究。结肠支架置入术也有局限性和潜在并发症,包括支架移位、再梗阻和穿孔。然而,SEMS置入术后根治性手术的时机仍无定论。根据目前的文献,在大约2周的间隔时间进行手术被认为是合适的。因此,结肠支架置入术可能是梗阻性结直肠癌患者手术过渡的有效策略。

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