使用刚性引导技术行支架置入术治疗结直肠癌梗阻的疗效分析  

The efficiency of using the stiff guidance technique in stent placement for treating the colorectal cancer obstruction

作　　者：许琳惠 任建庄[1] 段旭华[1] 陈鹏飞[1] 张文广[1] 万里 王家兴 邝东林 李方正[1] 韩新巍[1] Xu Linhui;Ren Jianzhuang;Duan Xuhua;Chen Pengfei;Zhang Wenguang;Wan Li;Wang Jiaxing;Kuang Donglin;Li Fangzheng;Han Xinwei(Interventional Radiology Department,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放射介入科,450052

出　　处：《中华结直肠疾病电子杂志》2020年第3期277-282,共6页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：河南省高等学校重点科研项目计划(No.19A320057)。

摘　　要：目的探讨使用刚性引导技术行金属支架置入术治疗结直肠癌梗阻的可行性及临床疗效。方法回顾性分析2014年1月至2018年9月收治的77例结直肠癌梗阻患者的临床资料,记录使用刚性引导技术行金属支架置入术的操作时间、术后24 h脐水平的腹围缩小程度、术后腹胀缓解时间、术后不良反应,分析技术成功率,临床成功率和并发症。结果77例结直肠癌梗阻的患者共置入金属支架85枚,技术成功率100%,手术时间30~240(中位50)min,其中6例患者置入2枚金属支架,1例患者置入3枚金属支架。患者术前测量脐水平的腹围为(107.8±12.1)cm,术后24 h降至(83.9±8.2)cm,缩小程度为(23.4±11.2)cm,术后中位腹胀缓解时间为1.9 d(1~6 d)。肠梗阻症状完全治愈62例(80.5%),症状改善9例(11.7%),症状无改善6例(7.8%),临床成功率为93.5%。3例(3.9%)患者出现腹痛症状,1例(1.3%)患者出现少量便血,无患者发生支架移位。26例患者于金属支架置入术后5~14 d行外科手术治疗,出现伤口感染1例,无肠漏、肠梗阻并发症;51例姑息性治疗患者支架通畅率1个月时为92.2%,3个月时为84.7%,6个月时为68.4%,12个月时为46.9%。结论数字减影血管造影技术(DSA)下金属支架置入术是治疗结直肠癌梗阻的一种安全有效的治疗措施,同时采用刚性的引导技术可提高技术成功率。Objective To investigate the feasibility and clinical efficacy of rigid technique in the treatment of colorectal cancer obstruction with metal stent.Methods Retrospective analysis of the clinical data of 77 patients with colorectal cancer obstruction admitted from January 2014 to September 2018,record the operation time of metal stent placement using rigid guiding technique,measure the degree of abdominal circumference reduction at 24 hours postoperatively,postoperative bloating relief time,postoperative adverse reations,analysis technique success rate,clinical success rate and complications.Results Seventy-seven patients with colorectal cancer obstruction were implanted with 85 metal stents,with a technical success rate of 100%and an operation time of 30~240 minutes(median 50 minutes),among which six patients were implanted with two metal stents,and one patient was placed with three metal stents.The abdominal circumference of the patient before the measurement of the umbilical level was(107.8±12.1)cm,and it decreased to(83.9±8.2)cm 24 hours after surgery,and the reduction was(23.4±11.2)cm,and the postoperative relief time of abdominal distension was(1~6 days)1.9 days.There were 62 cases(80.5%)with complete cure,nine cases(11.7%)with improvement,six cases(7.8%)without improvement,and the clinical success rate was 93.5%.Three patients(3.9%)had abdominal pain,and one(1.3%)had a small amount of blood in the stool.Surgical treatment was performed on 26 patients 5~14 days after metal stent implantation,and wound infection occurred in one patient,without complications of intestinal fistula and intestinal obstruction.The stent patency rate was 92.2%at one month,84.7%at three months,68.4%at six months and 46.9%at twelve months.Conclusion Metal stent implantation is a safe and effective treatment for colorectal cancer obstruction.Meanwhile,the rigid guidance technique can improve the technical success rate.

关 键 词：结直肠肿瘤 肠梗阻 结肠支架 

分 类 号：R735.34[医药卫生—肿瘤]