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低位直肠恶性梗阻支架置入相关挑战：一例报告

Challenges associated with low rectal malignant obstruction stenting: a case report.

作者信息

Cabrera-Bou Victor, Lincango Eddy P, Cabrera Alessandra E, Diaz-Pagan Gabriel, Kostick Nathan, Sobel Noah, Serrano Luis F, Kondylis Philip

机构信息

Surgery Department, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL 32816, United States.

Colorectal Surgery, HCA Florida Osceola Hospital, 700 W Oak St, Kissimmee, FL 34741, United States.

出版信息

J Surg Case Rep. 2024 Sep 10;2024(9):rjad593. doi: 10.1093/jscr/rjad593. eCollection 2024 Sep.

DOI:10.1093/jscr/rjad593
PMID:39257476
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11387049/
Abstract

An ongoing debate exists regarding the feasibility of placing self-expanding metallic stents (SEMS) within 5 cm of the anal verge. Traditionally, SEMS have been considered contraindicated for patients with a malignant rectal obstruction within this region due to potential impact on the anorectal ring or anal canal, which can cause incontinence, proctalgia, and tenesmus. However, in the case of a 63-year-old female who presented with distention, abdominal pain, and diminishing stool output, the rectal exam identified a bulky fixed mass. Imaging studies revealed large bowel obstruction and high-grade stricture, with a minuscule residual lumen. Endoscopy identified a bulky mass obscuring the lumen at 5 cm from the anal verge, and biopsy confirmed adenocarcinoma. Despite the traditionally held contraindication, a 2.5 cm × 9.0 cm colonic stent was successfully deployed, leading to brisk colonic decompression. This allowed the patient to promptly undergo chemoradiotherapy.

摘要

关于在距肛缘5厘米范围内放置自膨式金属支架（SEMS）的可行性，目前仍存在争议。传统上，由于可能影响肛管直肠环或肛管，该区域患有恶性直肠梗阻的患者一直被视为SEMS的禁忌证，这可能导致大便失禁、直肠疼痛和里急后重。然而，有一名63岁女性，出现腹胀、腹痛和大便排出减少的症状，直肠检查发现有一个巨大的固定肿块。影像学检查显示大肠梗阻和高度狭窄，仅残留极小的管腔。内镜检查发现距肛缘5厘米处有一个巨大肿块阻塞管腔，活检证实为腺癌。尽管有传统的禁忌证，但仍成功植入了一个2.5厘米×9.0厘米的结肠支架，实现了快速的结肠减压。这使患者能够迅速接受放化疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4412/11387049/162fc68589e9/rjad593f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4412/11387049/cae7d53edde3/rjad593f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4412/11387049/c5eb876cd0e3/rjad593f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4412/11387049/3c3df09d0e30/rjad593f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4412/11387049/f0625e6d211c/rjad593f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4412/11387049/162fc68589e9/rjad593f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4412/11387049/cae7d53edde3/rjad593f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4412/11387049/c5eb876cd0e3/rjad593f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4412/11387049/3c3df09d0e30/rjad593f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4412/11387049/f0625e6d211c/rjad593f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4412/11387049/162fc68589e9/rjad593f5.jpg

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本文引用的文献

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Management of obstructive colon cancer: Current status, obstacles, and future directions.梗阻性结肠癌的管理：现状、障碍及未来方向。
World J Gastrointest Oncol. 2021 Dec 15;13(12):1850-1862. doi: 10.4251/wjgo.v13.i12.1850.
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Endoscopic Management of Malignant Colonic Obstruction.恶性结肠梗阻的内镜治疗
Clin Endosc. 2020 Jan;53(1):9-17. doi: 10.5946/ce.2019.051. Epub 2020 Jan 7.
3
Endoscopic stenting of malignant, benign and iatrogenic colorectal disorders: a primer for radiologists.恶性、良性及医源性结直肠疾病的内镜支架置入术：放射科医生入门指南
Insights Imaging. 2019 Aug 28;10(1):80. doi: 10.1186/s13244-019-0763-1.
4
Colonic stenting as a bridge to surgery in malignant large bowel obstruction: oncological outcomes.结直肠支架置入术在恶性大肠梗阻中的桥接作用：肿瘤学结局。
Int J Colorectal Dis. 2019 Apr;34(4):613-619. doi: 10.1007/s00384-019-03239-9. Epub 2019 Jan 16.
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Colorectal Stents: Current Status.结直肠支架：现状
Clin Endosc. 2015 May;48(3):194-200. doi: 10.5946/ce.2015.48.3.194. Epub 2015 May 29.
6
Colonic stent-related complications and their management.结肠支架相关并发症及其处理
Clin Endosc. 2014 Sep;47(5):415-9. doi: 10.5946/ce.2014.47.5.415. Epub 2014 Sep 30.
7
Palliative treatment for incurable malignant colorectal obstructions: a meta-analysis.不可治愈的恶性结直肠梗阻的姑息治疗：一项荟萃分析。
World J Gastroenterol. 2013 Sep 7;19(33):5565-74. doi: 10.3748/wjg.v19.i33.5565.
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A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction.比较急性恶性结肠梗阻患者行紧急手术与支架置入术桥接手术的短期和中期疗效的研究。
Dis Colon Rectum. 2013 Apr;56(4):433-40. doi: 10.1097/DCR.0b013e3182760506.
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