Arrigoni A, Pennazio M, Spandre M, Rossini F P
Department of Oncology, San Giovanni A.S. Hospital, Turin, Italy.
Gastrointest Endosc. 1994 Sep-Oct;40(5):576-80. doi: 10.1016/s0016-5107(94)70256-x.
Endoscopic recanalization was attempted in 17 patients with obstruction caused by colorectal cancer who were at high surgical risk on account of their poor clinical condition. Combined use was made of pneumatic and mechanical dilation, debulking with a diathermal snare, and photoablation with neodymium-yttrium-aluminum-garnet laser. Successful recanalization was obtained in 94% of cases. The only failure was in a patient with a neoplasm of the rectosigmoid junction. Elective surgery was not performed on the patients after recanalization because of the presence of severe concomitant disease or diffuse metastasis. Patients were followed for 6.25 +/- 6.17 months with 1.6 +/- 0.7 treatments within the first month to stabilize patency and then with an average of 0.88 +/- 0.63 treatments per month to maintain patency. Only 2 patients had recurrence of obstruction, and the actuarial survival was 63% at 6 months and 23% at 1 year. Endoscopic treatment has proved effective because it allows rapid recanalization with resolution of emergency and maintenance of patency in patients for whom elective surgery is not indicated. In selected cases, therefore, endoscopic recanalization is a sound alternative to emergency surgery.
对17例因临床状况差而手术风险高的结直肠癌所致梗阻患者尝试进行内镜再通术。联合使用了气动和机械扩张、用透热圈套器减瘤以及用钕钇铝石榴石激光进行光消融。94%的病例成功实现再通。唯一失败的是一名直肠乙状结肠交界处肿瘤患者。再通术后未对患者进行择期手术，原因是存在严重的合并症或弥漫性转移。对患者进行了6.25±6.17个月的随访，第一个月内进行1.6±0.7次治疗以稳定通畅，之后平均每月进行0.88±0.63次治疗以维持通畅。只有2例患者出现梗阻复发，6个月时的精算生存率为63%，1年时为23%。内镜治疗已被证明是有效的，因为它能实现快速再通，缓解急症，并在不适合择期手术的患者中维持通畅。因此，在某些情况下，内镜再通术是急诊手术的合理替代方案。
