Tamaru Yuzuru, Kuwai Toshio, Hayashi Shiro, Nagaike Koji, Yakushijin Takayuki, Asai Satoshi, Yamamoto Masashi, Yamaguchi Shinjiro, Yamada Takuya, Hasatani Kenkei, Ihara Hideyuki, Tsumura Hidetaka, Doyama Hisashi, Maetani Iruru, Fujisawa Toshio, Ito Yukiko, Takagi Tadayuki, Hori Yasuki, Takenaka Mamoru, Hosono Makoto, Nishida Tsutomu
Department of Endoscopy, NHO Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan.
Department of Gastroenterology, NHO Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan.
J Clin Med. 2024 Oct 4;13(19):5924. doi: 10.3390/jcm13195924.
Although several reports have compared the outcomes of self-expandable metallic stent (SEMSs) and transanal decompression tube (TDT) placement for malignant colorectal obstruction (MCO), few studies have compared the radiation exposure (RE) associated with these two procedures. Consequently, we aimed to compare the RE of SEMS and TDT placements for MCO using propensity score matching (PSM) in a multi-center, prospective observational study. This study investigated the clinical data of 236 patients who underwent SEMS or TDT placement. The air kerma at the patient entrance reference point (K: mGy) and air kerma-area product (P; Gycm) were measured and compared between SEMS and TDT groups after PSM. After PSM, 61 patients were identified in each group. The median K in the SEMS group was significantly greater than that in the TDT group (77.4 vs. 55.6 mGy; = 0.025) across the entire cohort. With respect to subgroup analyses by location, in the rectum, the median K and P were significantly greater in the SEMS group than in the TDT group (172.9 vs. 34.6 mGy; = 0.001; and 46.0 vs. 18.1 Gycm; = 0.006, respectively). However, in the colon, the RE parameters did not significantly differ between the two groups. TDT might be a more suitable option for decompression in patients with malignant rectal obstruction due to its lower RE and technical advantages. Conversely, SEMS placement is recommended as the first decompression method to treat malignant colonic obstruction, in line with the current guidelines.
尽管有几份报告比较了自膨式金属支架（SEMS）和经肛门减压管（TDT）置入术治疗恶性大肠梗阻（MCO）的效果，但很少有研究比较这两种手术相关的辐射暴露（RE）。因此，我们旨在通过倾向评分匹配（PSM）在一项多中心前瞻性观察研究中比较SEMS和TDT置入术治疗MCO的RE。本研究调查了236例行SEMS或TDT置入术患者的临床资料。在PSM后，测量并比较SEMS组和TDT组在患者入口参考点的空气比释动能（K：mGy）和空气比释动能面积乘积（P；Gycm）。PSM后，每组确定61例患者。在整个队列中，SEMS组的K中位数显著高于TDT组（77.4对55.6 mGy；P = 0.025）。在按部位进行的亚组分析中，在直肠，SEMS组的K和P中位数显著高于TDT组（分别为172.9对34.6 mGy；P = 0.001；以及46.0对18.1 Gycm；P = 0.006）。然而，在结肠，两组的RE参数没有显著差异。由于TDT的RE较低且具有技术优势，它可能是恶性直肠梗阻患者减压的更合适选择。相反，根据当前指南，建议将SEMS置入术作为治疗恶性结肠梗阻的首选减压方法。
