经肠镜金属支架置入术治疗左侧大肠癌性梗阻的应用体会

The Application of Metal Stent for Treating Malignant Left Colorectal Obstruction by Endoscopy

目的探讨经结肠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线辅助下经电子结肠镜放置金属支架治疗15例左侧大肠癌性梗阻的病人,其梗阻部位分别为直肠9例,乙状结肠4例,降结肠2例.结果15例癌性梗阻患者中,13例放置成功,成功率为86.7%.术后梗阻症状即获得明显缓解或消除,至第2天梗阻症状完全消失.5例为姑息性治疗,8例患者解除梗阻后7d左右手术治疗,术中可见肠道准备满意,肠壁无明显水肿,术后恢复顺利.结论经电子结肠镜放置金属支架治疗左侧大肠癌性梗阻能迅速、有效、安全地解除患者的梗阻症状,创伤小,对可根治手术患者来说只需面临一次根治性手术.对姑息性治疗患者来说由于不需要开腹手术造瘘,故可显著提高患者的生活质量.

Objective To discuss the clinical value of metal stent for treating malignant left colorectal obstruction by endoscopy. Methods 15cases with left colorectal or rectal malignant obstruction were implanted metal stent by endoscopy under X-ray. Of these there were 9 cases in rectum, 4 in sigmoid colon, and 2 in descending colon respectively. Results Of 15 malignant obstruction, 13 （86.7%） were implanted the metal stent successfully. The symptom of obstruction released apparently after treatment, or even disappeared in the second day. 5 patients were treated palliative; another 8 patient were operated 7days after releasing obstruction. It＇s confirmed that the bowel had been prepared satisfactorily and no edema was detected in the bowel during the operation. The recovery after operation was successful. Conclusions Metal stent for treating malignant left colorectal obstruction by endoscopy can rapidly, effectively and safely release the syndrome, as well as has little injury. It can achieve the effectiveness of radical treatment to the suitable patients. It also can improve the life quality of patients in later stage who are not necessary to colonic stoma.