Baron T H, Dean P A, Yates M R, Canon C, Koehler R E
Department of Medicine, University of Alabama at Birmingham Medical Center, 35294-0007, USA.
Gastrointest Endosc. 1998 Mar;47(3):277-86. doi: 10.1016/s0016-5107(98)70327-x.
Acute left-sided colonic obstruction is a surgical emergency whose management is controversial. Because experience using expandable metal stents for relief of this type of obstruction is limited, we evaluated their effectiveness, feasibility, safety, and outcome.
Twenty-five patients with acute colorectal obstruction underwent placement of various metal stents under fluoroscopic and endoscopic guidance. On an intent-to-treat basis, stents were placed for decompression before one-stage surgical resection in 10 patients and palliatively in 15 patients. Two preoperative patients had unresectable malignant disease, and stents were left for palliation resulting in 17 palliative and 10 preoperative patients for analysis.
Stent placement was technically successful in 94% of patients. Overall effectiveness in relieving obstruction was 85% (palliative 82%, preoperative 90%). In the palliative group, stent duration ranged from 2 to 64 weeks (mean 17.3 weeks). Major complications occurred in 7 patients (30%).
Expandable metal stents are a feasible, effective adjunct and alternative to surgery for acute colorectal obstruction.
急性左侧结肠梗阻是一种外科急症，其治疗存在争议。由于使用可扩张金属支架缓解此类梗阻的经验有限，我们评估了其有效性、可行性、安全性及结局。
25例急性结直肠梗阻患者在荧光镜和内镜引导下置入了各种金属支架。基于意向性治疗原则，10例患者在一期手术切除前放置支架进行减压，15例患者为姑息性置入。2例术前患者患有无法切除的恶性疾病，置入支架进行姑息治疗，最终有17例姑息治疗患者和10例术前患者纳入分析。
94%的患者支架置入技术成功。缓解梗阻的总体有效率为85%（姑息治疗组82%，术前组90%）。在姑息治疗组，支架留置时间为2至64周（平均17.3周）。7例患者（30%）发生了严重并发症。
对于急性结直肠梗阻，可扩张金属支架是一种可行、有效的手术辅助手段及替代方法。
