覆膜金属支架置入治疗恶性肿瘤合并结肠、直肠瘘

Coated metal stents installation for the treatment of malignant tumors complicated with colonic and rectal fistula

目的探讨恶性肿瘤合并结肠或直肠瘘的临床特点及覆膜金属支架置入术的临床价值。方法晚期恶性肿瘤伴结肠、直肠瘘24例,其中肠癌16例(66.7%),胃癌及宫颈癌各2例(8.3%),膀胱、前列腺、卵巢和胆囊癌各1例(4.2%);肿瘤直接浸润穿瘘9例(37.5%),放疗后穿瘘15例(62.5%)。患者KPS评分30～60分,中位值40分。术前行CT检查,并经肛门插管造影明确瘘口位置、肠管走向、是否合并梗阻以及病灶与邻近组织关系。根据瘘口处肠道情况定制覆膜金属支架置入病变部位,观察瘘口封堵结果,随访并发症以及生存情况。结果实际操作23例。支架置入技术成功率为96%(22/23),1例因肠袢曲度过于锐利,支架无法释放;临床成功率为91.3%(21/23),2例分别因支架贴壁不良和移位仍存在轻微渗漏现象。随访28～365d,平均生存时间109d,中位值92d。3个月和6个月的生存率分别为51%和11%。结论肠瘘常见于胃肠道肿瘤术后或放疗后,是一种预后极差的肿瘤并发症,覆膜金属支架置入术为这类患者提供提高生活质量、延长生存时间的治疗选择。

Objective To probe the clinical features of malignant colonic and rectal tumors together with coated metal stent placement. Methods 24 cases of colonic fistula with late stage malignant tumors including 16 cases of intestinal cancer（66.7%）, 2 cases of gastric and cervical cancers respectively（8.3%）; 1 case of bladder, 1 case of prostate, 1 case of ovary and 1 case of gallbladder cancer（4.2%）. The cause for the fistulas were direct invasion （37.5%）and radiotherapy （62.5%）. The KPS was 30 - 60, and the median value was 40. CT were done preoperatively and followed by radiography of canulation contrast medium enema to ensure the location of the orifice of the fistula, the route of intestinal canal or complicated with obstruction and the condition with nearby tissues. Stents were finally implanted specifically according to the different situations of intestines. The sites of implanted stents and the occlusion of fistula should be strictly scrutinized; and then with careful follow up of patients complications and general condition. The procedure was carried out practically in 23 cases. Results The successful rate of technique reached 96%（22/23）, the failed one was due to the curve over sharpness of intestinal lock and resulting in non-expansion of the stent. The clinical successful rate was 91.3%. The two failed cased included the one with improper coherence to the intestinal wall leading to the stent migration and the other with a mild leakage after stent placement. The follow-up duration were 28 - 365 days, average 109 days, and the median value was 92 days. The average surviving period of 3 months and 6 months were 51% and 11% respectively. Conclusion Intestinal fistula is the common complication after intestinal tumor operation and radiotherapy with poor prognosis. Metal covered stents provide a therapy of choice to improve the life quality and prolong the life span.