结直肠癌梗阻的内支架治疗

Treatment of Colorectal Cancer Obstruction by Placement of Stents

目的探讨内支架治疗直肠乙状结肠癌并肠梗阻的方法和效果。方法对内科治疗无效的直肠乙状结肠癌并肠梗阻患者在X线和电子结肠镜下置入金属内支架,观察疗效及并发症。结果共治疗20例,男16例,女4例。年龄27～78岁,平均59.21岁。直肠癌14例,乙状结肠癌2例,乙状结肠癌术后复发并腹腔转移4例。成功率:14例直肠梗阻均一次性支架置放成功,成功率100%。6例乙状结肠梗阻一次性置放成功4例,1例首次置放国产支架失败,后改放进口支架成功,1例失败,成功率83.33%。总成功率95.00%。效果:支架置放后立即见粪便涌出,24小时所有支架置放成功,患者肠梗阻症状缓解,24小时后均恢复进食,术后3天复查X线平片肠梗阻均好转,短期有效率100%。12例术后3～7天行肠道准备后外科手术治疗,11例行I期手术根治术,术后未出现感染、吻合口漏等并发症;1例术中发现广泛转移行开关手术。4例患者因结肠癌术后复发并腹腔转移行支架永久性姑息治疗;3例因重要器官功能障碍无法耐受外科手术行支架永久性姑息治疗。8例永久性支架治疗患者随访,1例患者术后36天出现肠梗阻症状复发,CT考虑支架阻塞,行外科手术,术后5天死于心衰。1例患者于术后62天出现肠梗阻症状,CT示腹腔广泛转移至其他部位肠梗阻死亡。1例患者于术后80天死于全身衰竭。另5例患者随访90～180天,支架保持通畅,病人情况良好。并发症:1例患者手术后出现便血加重,经药物治疗1周后好转。未出现其他并发症。结论在内镜联合X线下金属支架置入治疗直肠乙状结肠癌并肠梗阻成功率高,安全,短期效果明显。

Objective: To explore the method and efficacy of endoscopic stenting in colorectal cancer obstruction. Methods: Those patients with colorectal cancer obstruction who were refractory to medical treatment were treated by metal internal stents placement via electronic colonoscope under the x-ray guidance,then observe the curative effect and the complication. Results: Twenty pantients underwent stent placement,among them,16 were male,4 were female.Age range from 27 to 78,average 59.21 years old.14 cases were re...