Rey J F, Romanczyk T, Greff M
Institut Arnault Tzanck, Saint-Laurent du Var, France.
Endoscopy. 1995 Sep;27(7):501-4. doi: 10.1055/s-2007-1005755.
Laser therapy is often the only alternative to palliative surgery for elderly patients with advanced rectal carcinoma. In order to reduce the number of laser sessions required, we tried to insert metal stents after initial relief of the obstruction.
In 12 patients (seven female, five male, aged 77-91 years) with rectal or rectosigmoid carcinomas, metallic self-expanding stents (length 5-10 cm, internal diameter 1-2 cm) were introduced. Initial treatments were performed with Nd:YAG laser (mean number of sessions 3.1) in order to allow free passage of an adult colonoscope. Endoscopic and clinical follow-up was carried out at regular intervals.
Stent insertion was possible in 11 of the 12 patients. Failure occurred in one patient with sigmoid carcinoma with a distorted loop and diverticulosis. In three patients, the prostheses migrated due to the opening of the lumen being too large; after stent removal, a second stent was successfully placed. Seven patients have died since the beginning of the study, all from the initial disease, without symptoms of stent occlusion. Stenting allowed the number of laser sessions to be reduced. The interval between the laser sessions was extended from 5.1 weeks in a historical control group of 65 patients to the 9.7 weeks in these 11 patients with additional stenting.
Stenting for rectal carcinoma is technically feasible and safe, and probably reduces the number of laser sessions required. However, better materials are required.
对于晚期直肠癌老年患者，激光治疗常常是姑息性手术的唯一替代方案。为了减少所需的激光治疗次数，我们尝试在梗阻初步缓解后植入金属支架。
对12例（7例女性，5例男性，年龄77 - 91岁）患有直肠癌或直肠乙状结肠癌的患者植入了金属自膨式支架（长度5 - 10厘米，内径1 - 2厘米）。最初采用Nd:YAG激光进行治疗（平均治疗次数3.1次），以便成人结肠镜能够自由通过。定期进行内镜和临床随访。
12例患者中有11例成功植入支架。1例患有乙状结肠癌且肠袢扭曲并有憩室病的患者植入失败。3例患者因管腔开口过大导致假体移位；取出支架后，成功植入了第二个支架。自研究开始以来，7例患者死亡，均死于初始疾病，无支架阻塞症状。植入支架减少了激光治疗次数。激光治疗间隔从65例患者的历史对照组的5.1周延长至这11例额外植入支架患者的9.7周。
直肠癌植入支架在技术上可行且安全，可能会减少所需的激光治疗次数。然而，需要更好的材料。
