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  

The Clinical Analysis of Colon Self-expanding Metal Stents without Fluoroscopic Monitoring for the Transitional Treatment of Acute Obstruction in Colorectal Cancer Patients

作　　者：刘祺[1] 卢太亮 董宏宇[1] 房志学[1] 黄兴[1] 吴俊杰 黄忠诚[1] LIU Qi;LU Tai-liang;DONG Hong-yu;FANG Zhi-xue;HUANG Xing;WU Jun-jie;HUANG Zhong-cheng(Department of Colorectal and Anus Surgeu, Hunan Prvince People＇s Hospital, Changsha 410005, Hunan, China)

机构地区：[1]湖南省人民医院结直肠肛门外科,长沙410005

出　　处：《中国现代手术学杂志》2018年第1期1-5,共5页Chinese Journal of Modern Operative Surgery

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.

关 键 词：结直肠肿瘤 结肠梗阻 结肠支架 非透视 结肠镜检查 

分 类 号：R735.3[医药卫生—肿瘤]