自膨式金属支架对左半和右半结肠恶性梗阻的治疗效果研究  

Clinical outcomes of self-expandable metal stent placement for malignant left-sided and right-sided colon obstruction

作　　者：李荣雪 焦月 张澍田 冀明 LI Rong-xue;JIAO Yue;ZHANG Shu-tian(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing Digestive Disease Center,Faculty of Gastroenterology of Capital Medical University ,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases,Beijing 100050,China.)

机构地区：[1]首都医科大学附属北京友谊医院消化内科国家消化系统疾病临床医学研究中心北京市消化疾病中心首都医科大学消化病学系消化疾病癌前病变北京市重点实验室

出　　处：《临床和实验医学杂志》2019年第18期1992-1996,共5页Journal of Clinical and Experimental Medicine

基　　金：北京市医院管理局消化内科学科协同发展中心项目(编号:XXZ0104);首都医科大学附属北京友谊医院科研启动基金(编号:YYQDKT2016-55)

摘　　要：目的探讨自膨式金属支架(SEMS)对左半结肠和右半结肠恶性梗阻的治疗价值。方法采用回顾性研究方法,选取2012年4月至2018年12月首都医科大学附属北京友谊医院收治的恶性结直肠梗阻行SEMS置入的200例次,根据梗阻部位分为左半结肠组(LSCO组,n=172)和右半结肠组(RSCO组,n=28)。观察两组的技术成功率、临床成功率、操作用时,以及术后并发症情况。结果 LSCO组和RSCO组的技术成功率分别为100%(172/172)、92. 9%(26/28),差异具有统计学意义(P=0. 019);临床成功率分别为93. 5%(129/138)、83. 3%(20/24),差异无统计学意义(P=0. 091)。中位操作时间分别为24 min、19 min,差异无统计学意义(P=0. 223)。随访143例次,中位随访时间24(73) d。LSCO组和RSCO组SEMS术后并发症的发生率分别为19. 5%(24/123)、5. 0%(1/20),差异无统计学意义(P=0. 113)。其中LSCO组中,出现肠穿孔7例(7/123,5. 7%),穿孔时间为术后1~75 d,中位时间为9 d;再发肠梗阻12例,发生于SEMS后12~316 d,中位时间为69 d,9例再次置入支架后梗阻解除。结论 SEMS对治疗左、右半结肠恶性梗阻均有效;对再发肠梗阻,二次置入支架是有效的治疗方法。Objective To investigate the therapeutic value of self-expandable metal stent( SEMS) for left-sided and right-sided malignant colon obstruction. Methods In this retrospective study,200 cases of malignant colon obstruction who underwent SEMS placement in Beijing Friendship Hospital from April 2014 to December 2018 were enrolled. According to the site of obstruction,the patients were divided into left-sided colon obstruction group( LSCO) and right-sided colon obstruction group( RSCO),with 172 cases and 28 cases respectively. The technical success rate,clinical success rate,procedure time and complications were analyzed. Results Technical success was achieved in 172/172( 100%) patients in LSCO group and in 26/28( 92. 9%) patients in RSCO group,with significant difference between groups( P = 0. 019).Clinical success rates were 93. 5%( 129/138) and 83. 3%( 20/24),with no significant difference between groups( P = 0. 091). Median procedure time was comparable( 24 min vs 19 min,P = 0. 223). A total of 143 cases were followed up and the median follow-up time was 24 days with a interquartile interval of 73 days. Complication rates were 19. 5%( 24/123) and 5. 0%( 1/20) in LSCO group and RSCO group,respectively,with no significant difference between groups. Perforation was reported in seven of 123 cases in the LSCO group,accounting for 5. 7%. Colon perforation occurred between 1 day to 75 days after SEMS placement,with a median time of 9 days. During the follow-up,12 cases of recurrence of obstruction were reported,which happened between 12 days and 316 days after SEMS placement,with a median time of 69 days. In these re-obstruction patients,9 cases were successfully relieved by secondary SEMS insertion. Conclusion SEMS placement is an effective and relatively safe treatment for both proximal and distal colon obstruction. Secondary stent insertion is a valid alternative for recurrence of obstruction.

关 键 词：恶性结肠梗阻 自膨式金属支架 结肠癌 

分 类 号：R735.34[医药卫生—肿瘤]