DSA引导下自膨式金属支架治疗晚期左半结肠癌合并急性肠梗阻的临床分析  

The clinical analysis of DSA-assisted self-expandable metallic stent in treatment of advanced left colon carcinoma with acute intestinal obstruction

作　　者：王刚[1] 毕聪 潘鑫[2] Wang Gang;Bi Cong;Pan Xin(Department of Intervention,the Fourth Affiliated Hospital of China Medical University,Liaoning Shenyang 110032,China;Department of Radiology,the Fourth Affiliated Hospital of China Medical University,Liaoning Shenyang 110032,China)

机构地区：[1]中国医科大学附属第四医院介入科,辽宁沈阳110032 [2]中国医科大学附属第四医院放射科,辽宁沈阳110032

出　　处：《现代肿瘤医学》2020年第12期2075-2079,共5页Journal of Modern Oncology

摘　　要：目的:探讨在DSA(数字减影血管造影)引导下置入钛镍记忆合金支架治疗晚期左半结肠癌合并急性肠梗阻的可行性与临床疗效。方法:选择2012年1月至2017年1月120例符合条件的晚期左半结肠癌合并急性肠梗阻患者,其中60例在DSA引导下行永久性支架植入姑息治疗(支架组),另60例行常规急诊手术治疗(对照组),比较两组患者的相关临床指标。结果:支架组手术成功率为93.3%,并发症发生率为8.33%(术后发生支架再狭窄3例,肠穿孔2例),患者术后即可下床活动,不需人工肛门,术后随访1年生存率为96.7%;对照组手术成功率为100.0%,并发症发生率为31.6%(术后发生切口感染8例,肺内感染8例,腹腔感染3例),术后1年随访生存率为95%,所有随访患者均未进行放化疗。术后两组患者肠梗阻症状均明显缓解,但支架组与对照组相比,肠梗阻症状缓解更迅速,并发症发生率低,而且生活质量得到明显提高,住院费用更少,差异均有统计学意义(均P<0.05)。结论:针对左半结肠癌合并梗阻的患者,DSA引导下置入的钛镍记忆合金支架可迅速缓解梗阻症状,具有操作简单、创伤小、并发症少、减轻患者痛苦、提高生活质量等优点,并且患者生存时间与外科手术相当。Objective:To explore the feasibility and clinical efficacy of placing titanium-nickel memory alloy stents under the guidance of DSA(digital subtraction angiography)for the treatment of advanced left colon carcinoma with acute intestinal obstruction.Methods:From January 2012 to January 2017,120 cases with left colon cancer with acute obstruction patients were collected,including 60 cases in DSA guiding permanent stents palliative care(stent group),the other 60 routine emergency surgery(control group).Two groups of patients with clinical indicators were compared.Results:The success rate of the stents group was 93.3%,and the incidence of complications was 8.33%(3 cases of stent restenosis after surgery,2 cases of intestinal perforation).Patients can get out of bed after operation without artificial anus,and the 1 year survival rate was 96.7%.The success rate of the control group was 100.0%,and the complication rate was 31.6%(8 cases with incisional wound infection,8 cases of pulmonary infection and 3 cases of abdominal infection),and the survival rate was 95.0%after 1 year.All patients who were followed up did not undergo radiotherapy and chemotherapy.Two groups of patients with postoperative intestinal obstruction symptoms were significantly,but compared with control group,in stents group,the intestinal obstruction symptom was relieved more quickly,and there was lower incidence of complications,and a considerable improvement of the quality of life and less hospitalization expenses.Differences were statistically significant(all P<0.05).Conclusion:In view of the left colon carcinoma obstruction combined,DSA guided placement of titanium-nickel memory alloy stent can rapidly relieve obstruction symptoms,has simple operation,small trauma,fewer complications,reduce the patients pain and improve the quality of life,and the patient’s survival time is comparable to that of surgery.

关 键 词：结肠支架 左半结肠肿瘤 肠梗阻 

分 类 号：R735.3[医药卫生—肿瘤]