经内镜金属支架置入术治疗左侧大肠癌性梗阻的临床价值

The Clinical Value of Endoscopic Metal Stenting for Malignant Left Colorectal Obstruction

目的探讨经内镜金属支架置入术治疗左侧大肠癌性梗阻的临床价值。方法在X线辅助下经内镜放置支架治疗22例左侧大肠癌性梗阻的病人,其梗阻的部位分别为直肠14例,乙状结肠6例,降结肠2例。结果22例大肠癌性梗阻中,20例放置支架成功,成功率为90.9%,术后1～2天梗阻症状均得到缓解或消除,其中14例为姑息治疗,6例经内镜治疗解除梗阻后7～10天接受外科手术治疗,术后均恢复顺利,无感染及吻合口漏等并发症发生。1例直肠癌术后复发伴盆腔广泛转移者治疗失败,1例乙状结肠癌广泛转移者术中穿孔而急诊行Hartmann术。1例术后6周支架远端移位,导致梗阻复发,置入第二根支架后缓解。1例术后1月粪块堵塞支架,以探条及网篮疏通后缓解。结论经内镜放置金属支架治疗左侧大肠癌性梗阻,能够有效缓解患者的梗阻症状,操作简单、经济有效,并发症少,可以显著降低病人的创伤和痛苦,提高病人的生活质量。

Objective： To evaluate the clinical value of endoscopic metal stenting for malignant left colorectal obstruction. Methods： With the aid of fluoroscopy, 22 cases with malignant left colorectal obstruction were treated with endoscopic metal stenting. Their obstructive sites consisted of rectum（n=14）, sigmoid colon（n=6）descending colon（n=2）. Results： Of 22 patients, 20 cases were successfully inserted metal stents （20/22, 90.9%）, and showed relief of symptoms within 1-2 days. Permanent metal stent placement was performed in 14 cases for palliative treatment, 6 underwent subsequent elective surgical resection after 7-10 days, without complications of anastomotic leakage and intraperitoneal infection. One case with recurrent rectal carcinoma after resection was failure, one case with widespread metastatic sigmoid colon carcinoma occurred colon perforation and received immediate Hartmann operation. Recurrent obstruction was detected in one patient with distal stent migration within 6 weeks, and second stent were placed to solve the problems. Stent occlusion from stool impaction was found in one patient 1 month after stent insertion, and was solved by endoscpic interventions. Conclusions： Endoscopic placement of metal stent can loosen the malignant left colorectal obstructive sympotoms with high success rate. It is a simple, safe, effective and well tolerated method, and can reduce the patients＇ trauma and pain, and increase the patients＇ living quality.