非透视结肠自扩张金属支架置入过渡治疗急性梗阻性结直肠癌的临床分析
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摘要
目的探讨非透视下结肠自扩张金属支架置入治疗急性梗阻性结直肠癌患者的安全性和有效性。方法回顾性分析2014年3月至2017年12月湖南省人民医院63例非透视结肠自扩张金属支架置入治疗急性梗阻性结直肠癌患者的临床资料。采用双人肠镜操作法,进镜至肿瘤部位后探寻狭窄孔并插入非血管腔道导丝,沿导丝将自扩张金属支架置入并通过狭窄段,释放支架于目的位置。结果 63例急性梗阻性结直肠癌患者中升结肠及结肠肝曲癌1例,横结肠癌2例,结肠脾曲癌6例,降结肠癌9例,乙状结肠癌29例,直乙交界及直肠癌16例。支架置入成功率100%,支架置入操作时间为5~35 min,平均(12.3±4.6)min。除1例严重感染合并水电解质酸碱平衡紊乱患者术后1 d死亡外,其余患者均术后第2 d进食流质饮食,2~4 d左右临床症状完全缓解,于术后2~3周手术治疗。结论非透视下结肠自扩张金属支架置入治疗急性梗阻性结直肠癌患者安全有效,是急性梗阻性结直肠癌由急诊手术向限期手术转变的有效过渡治疗手段。
Objective To evaluate the efficacy and safety of colonoscopy guided placement of self-expanding metallic stents(SEMS) without fluoroscopic monitoring in the emergence management for acute malignant colorectal obstruction. Methods Clinical data of 63 patients undergoing colonoscopy guided placement of self-expanding metallic stents without fluoroscopic monitoring for acute malignant colorectal obstruction between March,2014 and December,2017 were reviewed retrospectively. Results The obstruction was located in the ascending colon and hepatic flexure(n = 1),transverse colonic carcinoma(n = 2),splenic flexure(n= 6),descending colon(n = 9),sigmoid(n = 29),rectosigmoid junction and rectum(n = 16). Technical success was achieved in all the 63 patients(100%). Mean time of operation was(12. 3 ± 4. 6) min(range,5~ 35 min). One patient died on the first day after operation because of severe infection with electrolyte acidbase balance disorder. The rest patients received liquid diet on the second day after operation,and the clinical symptoms were completely relieved within 2 ~ 4 days. Colorectal cancer radical surgery was performed 2 ~ 3 weeks after the colon self-expanding metal stenting. Conclusions Colonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring in emergence management for acute malignant colorectal obstruction is effective and safe. It is a useful transitional treatment for acute obstructive colorectal cancer from emergency operation to limited operation.
Objective To evaluate the efficacy and safety of colonoscopy guided placement of self-expanding metallic stents(SEMS) without fluoroscopic monitoring in the emergence management for acute malignant colorectal obstruction. Methods Clinical data of 63 patients undergoing colonoscopy guided placement of self-expanding metallic stents without fluoroscopic monitoring for acute malignant colorectal obstruction between March,2014 and December,2017 were reviewed retrospectively. Results The obstruction was located in the ascending colon and hepatic flexure(n = 1),transverse colonic carcinoma(n = 2),splenic flexure(n= 6),descending colon(n = 9),sigmoid(n = 29),rectosigmoid junction and rectum(n = 16). Technical success was achieved in all the 63 patients(100%). Mean time of operation was(12. 3 ± 4. 6) min(range,5~ 35 min). One patient died on the first day after operation because of severe infection with electrolyte acidbase balance disorder. The rest patients received liquid diet on the second day after operation,and the clinical symptoms were completely relieved within 2 ~ 4 days. Colorectal cancer radical surgery was performed 2 ~ 3 weeks after the colon self-expanding metal stenting. Conclusions Colonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring in emergence management for acute malignant colorectal obstruction is effective and safe. It is a useful transitional treatment for acute obstructive colorectal cancer from emergency operation to limited operation.
引文
[1]Mizrahi H,Geron N,Parker MC.The outcome of self-expanding metal stents in elderly patients[J].JSLS,2014,18(3).pii:e2014.00038.doi:10.4293/JSLS.2014.00038.
[2]Dohmoto M.New method:endoscopic implantation of rectal stent in palliative treatment of malignant stenosis[J].Endosc Dig,1991,3:1507-1512.
[3]韦振轩,陈小勋.X线辅助内镜置入支架联合腹腔镜手术治疗结直肠癌并梗阻的疗效分析[J].中国普通外科杂志,2016,25(4):475-480.
[4]Van Hooft JE,Van Halsema EE,Vanbiervliet G,et al.Self-expandable metal stents for obstructing colonic and extra colonic cancer:European Society of Gastrointestinal Endoscopy(ESGE)Clinical Guideline[J].Gastrointest Endosc,2014,80(5):747-761.
[5]赵兴旺,刘正,王锡山.自膨胀金属支架在癌性肠梗阻治疗中的临床疗效分析[J].中国全科医学,2016,19(3):259-263.
[6]闫飞虎,曹光材,刘小双,等.结肠镜非透视下自扩张金属支架在处理梗阻性结直肠癌中的临床应用研究[J].中华航海医学与高气压医学杂志,2016,23(4):293-297.
[7]de Gregorio MA,Laborda A,Tejero E,et al.Ten-year retrospective study of treatment of malignant colonic obstructions with selfexpandable stents[J].J Vasc Interv Radiol,2011,22(6):870-878.doi:10.1016/j.jvir.2011.02.002.
[8]楼征,于恩达,张卫,等.结肠镜非透视下金属支架置入术在梗阻性结直肠癌患者急诊处理中的应用[J].中华胃肠外科杂志,2013,16(4):363-366.
[9]Chouhan H,Wong CX,Maharaj P,et al.Colorectal stenting for malignant obstruction:an 8-year clinical experience[J].ANZ J Surg,2012,82(6):408-411.doi:10.1111/j.1445-2197.2012.06086.x.
[10]Kernen I,Lepist9 A,Udd M,et al.Stenting for malignant colorectal obstruction:a single-center experience with 101 patients[J].Surg Endosc,2012,26(2):423-430.doi:10.1007/s00464-011-1890-z.
[11]Choi JH,Lee YJ,Kim ES,et al.Covered self-expandable metal stents are more associated with complications in the management of malignant colorectal obstruction[J].Surg Endosc,2013,27(9):3220-3227.doi:10.1007/s00464-013-2897-4.
[12]陈俊杰,赖亚栋,李东升,等.肠道支架及肠梗阻导管治疗急性左半结直肠癌性梗阻的研究[J].中华消化内镜杂志,2016,33(4):252-254.
[2]Dohmoto M.New method:endoscopic implantation of rectal stent in palliative treatment of malignant stenosis[J].Endosc Dig,1991,3:1507-1512.
[3]韦振轩,陈小勋.X线辅助内镜置入支架联合腹腔镜手术治疗结直肠癌并梗阻的疗效分析[J].中国普通外科杂志,2016,25(4):475-480.
[4]Van Hooft JE,Van Halsema EE,Vanbiervliet G,et al.Self-expandable metal stents for obstructing colonic and extra colonic cancer:European Society of Gastrointestinal Endoscopy(ESGE)Clinical Guideline[J].Gastrointest Endosc,2014,80(5):747-761.
[5]赵兴旺,刘正,王锡山.自膨胀金属支架在癌性肠梗阻治疗中的临床疗效分析[J].中国全科医学,2016,19(3):259-263.
[6]闫飞虎,曹光材,刘小双,等.结肠镜非透视下自扩张金属支架在处理梗阻性结直肠癌中的临床应用研究[J].中华航海医学与高气压医学杂志,2016,23(4):293-297.
[7]de Gregorio MA,Laborda A,Tejero E,et al.Ten-year retrospective study of treatment of malignant colonic obstructions with selfexpandable stents[J].J Vasc Interv Radiol,2011,22(6):870-878.doi:10.1016/j.jvir.2011.02.002.
[8]楼征,于恩达,张卫,等.结肠镜非透视下金属支架置入术在梗阻性结直肠癌患者急诊处理中的应用[J].中华胃肠外科杂志,2013,16(4):363-366.
[9]Chouhan H,Wong CX,Maharaj P,et al.Colorectal stenting for malignant obstruction:an 8-year clinical experience[J].ANZ J Surg,2012,82(6):408-411.doi:10.1111/j.1445-2197.2012.06086.x.
[10]Kernen I,Lepist9 A,Udd M,et al.Stenting for malignant colorectal obstruction:a single-center experience with 101 patients[J].Surg Endosc,2012,26(2):423-430.doi:10.1007/s00464-011-1890-z.
[11]Choi JH,Lee YJ,Kim ES,et al.Covered self-expandable metal stents are more associated with complications in the management of malignant colorectal obstruction[J].Surg Endosc,2013,27(9):3220-3227.doi:10.1007/s00464-013-2897-4.
[12]陈俊杰,赖亚栋,李东升,等.肠道支架及肠梗阻导管治疗急性左半结直肠癌性梗阻的研究[J].中华消化内镜杂志,2016,33(4):252-254.
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