13例直肠癌术后吻合口管状狭窄行内镜下支架置入治疗的效果分析  

Endoscopic stenting for anastomotic tubular stricture after rectal cancer surgery:an analysis of 13 cases

作　　者：余腾江 李五生 李时超 陈卫东 兰勇 杨向东[2] 贾英田 Yu Tengjiang;Li Wusheng;Li Shichao;Chen Weidong;Lan Yong;Yang Xiangdong;Jia Yingtian(Department of Coloproctology,The Affiliated Traditional Chinese Medicine Hospital of the Southwest Medical University,Lu-zhou 646000,Sichuan,China;DepartmentⅠof Anorectal Diseases,Chengdu Anorectal Hospital,Chengdu 610000,Sichuan,China)

机构地区：[1]西南医科大学附属中医医院肛肠科,四川泸州646000 [2]成都肛肠专科医院肛肠一科,四川成都610000

出　　处：《结直肠肛门外科》2022年第6期603-606,共4页Journal of Colorectal & Anal Surgery

基　　金：西南医科大学附属中医医院科研项目(2020XYLH-039)。

摘　　要：目的分析直肠癌术后吻合口管状狭窄行内镜下支架置入治疗的效果。方法回顾性分析2018年3月至2022年2月在西南医科大学附属中医医院肛肠科接受内镜下支架置入治疗的13例直肠癌术后吻合口管状狭窄患者的临床资料,患者既往均接受过3次内镜下切开、球囊扩张治疗。记录内镜下支架置入治疗的相关情况及疗效(有效,好转或无效)。结果13例患者中,10例患者术中治疗顺利,支架安置位置合适;3例患者术中支架安置位置过高,在内镜下用异物钳予以调整至头端超过吻合口1 cm。平均手术时间为(27.8±5.2)min;平均住院时间为(5.2±1.4)d。术后2例患者出现局部中度疼痛,8例患者出现肛门坠胀不适。患者未出现支架移位、肠穿孔等并发症。支架留置的平均时间为(16.5±1.7)d。支架置入术后6个月完善电子结肠镜检查进行疗效评估认为9例有效,3例好转,1例无效。9例治疗有效的患者的吻合口口径较术前增大,电子结肠镜可顺利通过。结论内镜下支架置入治疗直肠癌术后吻合口管状狭窄的总体疗效较为理想,安全性良好。对于多次经内镜下切开、球囊扩张治疗失败者,可考虑行该术式治疗。Objectives To determine the effectiveness of endoscopic stenting for anastomotic tubular stricture after rectal cancer surgery.Methods This was a retrospective analysis of 13 patients with anastomotic tubular stricture after rectal cancer surgery treated with endoscopic stenting at the Department of Coloproctology,the Affiliated Traditional Chinese Medicine Hospital of the Southwest Medical University,between March 2018 and February 2022.All patients had been treated with endoscopic incision and balloon dilation three times before endoscopic stenting.Parameters related to the treatment and the effectiveness(effective,improved,or ineffective)of endoscopic stenting were recorded.Results Of the 13 patients,the procedure was uneventful in 10 patients;in the remaining 3 patients,stents were placed too high and required adjustment of the head end to 1 cm above the anastomosis using foreign body forceps under endoscopy.The mean(SD)duration of surgery was 27.8(5.2)mins;the mean(SD)duration of hospitalization was 5.2(1.4)days.Two patients experienced medium local postoperative pain,and eight had anal distension.No patients had complications such as stent migration or intestinal perforation.The mean(SD)stent indwelling time was 16.5(1.7)days.Evaluated by colonoscopy 6 months after stenting,the procedure was deemed effective in nine patients,improved in three patients,and ineffective in one patient.For the nine patients in whom the procedure was deemed effective,the diameter of the anastomosis was enlarged compared with pre-procedure,and the colonoscopy could pass through smoothly.Conclusion Endoscopic stenting is an effective procedure with good safety profile for anastomotic tubular stricture after rectal cancer surgery.It can be considered one treatment option for patients who have failed endoscopic incision and balloon dilation multiple times.

关 键 词：良性吻合口狭窄 吻合口管状狭窄 直肠癌 内镜下支架置入术 

分 类 号：R735.37[医药卫生—肿瘤]