支架或导管缓解恶性大肠梗阻的回顾性队列研究  

Self-expanding metallic stent or transanal drainage tube in malignant large-bowel obstruction:an observational cohort study

作　　者：魏晶晶[1] 刘鹭鹏 庄则豪[1] 王承党[1] 郑建涛[2] 陈群[2] 丁健[1] 潘玉凤[1] WEI Jing-jing;LIU Lu-peng;ZHUANG Ze-hao;WANG Cheng-dang;ZHENG Jian-tao;CHEN Qun;DING Jian;PAN Yu-feng(Department of Endoscopy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China;Department of Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China)

机构地区：[1]福建医科大学附属第一医院内镜中心,福州350005 [2]福建医科大学附属第一医院胃肠外科,福州350005

出　　处：《肿瘤代谢与营养电子杂志》2017年第1期83-87,共5页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：福建医科大学启航基金(2016QH070)

摘　　要：目的比较SEMS和TDT置入在恢复恶性大肠梗阻中的应用价值。方法收集单中心2012~2016年接受SEMS(n=26)和TDT(n=22)置入的48例恶性大肠梗阻患者资料,比较两组技术成功率、临床症状缓解情况、并发症、达开放EN时长、功能状态评估及后续治疗选择等指标。结果两组技术成功率均为100%,无穿孔发生。SEMS组和TDT组梗阻症状缓解比例分别为96.2%(25/26)和95.5%(21/22),导管移位分别为7.7%(2/26)和18.2%(4/22)(P=0.26,达开放EN时长为2 IQR(0~2)天和3 IQR(2~5)天(P=0.001),KPS功能状态评分为75 IQR(50~80)分和35 IQR(30~50)分(P=0.001)。接受外科手术、单用化疗和不接受手术或化疗而行口服营养补充的患者比例在SEMS组为30.8%(8/26)、7.7%(2/26)和61.5%(16/26),在TDT组为31.8%(7/22)、0和59.1%(13/22);其中二期手术的患者比例在SEMS和TDT组分别为25.0%(2/8)和57.1%(4/7),吻合口瘘仅见于TDT组(1/7)。结论 SEMS和TDT法均能有效缓解恶性大肠梗阻症状,技术成功率及安全性好。SEMS开放EN更快、术后功能状态更优。Objective To compare the outcomes after SEMS or TDT placement in patients with malignant large-bowel obstruction(MLBO).Methods48patients with MLBO from the clinical unit accepted SEMS(n=26)or TDT(n=22)placement from2012to2016were collected.The outcomes evaluation,successful rates of placement,clinical outcomes after decompression,complications,the timing of resuming to EN,Karnofsky Performance Status(KPS)scoring and the following-up therapeutic options were included.Results Technical success were achieved in100%patients in both groups.Clinical success rates were96.2%(25/26)for SEMS and95.5%(21/22)for TDT.There was no perforation found in any group,while7.7%(2/26)in SEMS and18.2%(4/22)in TDT group experiencing a complication of displacement(P=0.26).2IQR(0~2)days and3IQR(2~5)days should be taken toresume to EN in each group,respectively(P=0.001).KPS scores were significantly higher in patients with SEMS(75IQR50~80)than in those with TDT(35IQR30~50)(P=0.001).There were30.8%(8/26)patients undergoing stenting as bridge to surgery,7.7%(2/26)patients for chemotherapy only and61.5%(16/26)for palliation and nutritional therapy in SEMS group,while31.8%(7/22),0and59.1%(13/22)in TDT group,respectively(P=0.36).The patients requiring stoma creation were57.1%(4/7)in TDT group and25.0%(2/8)in SEMS group,respectively,while postoperative anastomotic leakage was found only in TDT group(1/7).Conclusions Both SEMS and TDT placement could achieve a clinical relief for MLBO effectively.However,SEMS placement is associated with earlier EN and is more obvious postoperative quality-of-life benefits in MLBO.

关 键 词：恶性大肠梗阻 自膨式金属支架 经肛肠梗阻导管 卡氏功能状态量表 肠内营养 

分 类 号：R735.34[医药卫生—肿瘤]