记忆金属支架与植入用缓释氟尿嘧啶联合治疗晚期梗阻性直肠癌

Shape memory alloy stent insertion combined with adjuvant chemotherapy by implantation of sustained-releasing 5-fluorouracil in obstructing rectal cancers

目的:探讨记忆金属支架与植入用缓释氟尿嘧啶(中人氟安)联合治疗直肠癌伴梗阻的疗效及意义。方法:对直肠癌伴梗阻14例,首先经肛门置入肠道支架治疗梗阻,再经支架网眼穿刺植入缓释氟尿嘧啶局部化疗。结果:成功置入支架后即解除梗阻。1例因严重体液失调导致神志不清,治疗1周后才恢复饮食,其他患者1～3 d后即逐渐恢复饮食。全部病例均获随访,时间为3个月～2年。1例在置入支架后94 d随大便脱出,并于脱落后22 d因梗阻复发再次置入支架。现已死亡10例,生存期101～720 d,平均(352±221)d;其余4例已存活3～13个月,未再发生肠梗阻。结论:利用记忆金属支架能有效解除直肠癌伴梗阻,可对晚期直肠癌以及具有高危手术因素的患者施行永久性姑息治疗,避免结肠造口;置入支架后经支架网眼穿刺植入缓释氟尿嘧啶局部化疗,有利于延长患者生存期。

Objective： To evaluate efficacy and significance of stent insertion combined with adjuvant chemotherapy by implantation of sustained-releasing 5-fluorouracil in patients with intestinal obstruction due to rectal cancer.Methods： Fourteen patients with acute or chronic rectal obstructions from malignant causes underwent stent placement as well as implantation of sustained-releasing 5-fluorouracil.Results：The patients were immediately relieved the symptoms of intestinal obstruction after stent insertion Except on case due to the disorders in body fluid balance occurred.This patient resumed diet in 7 days,others resumed diet in 1～3 days.In 14 patients who had a follow-up 3～24 months stent got out during defecation in one case.Ten cases died within 101～720 days（average 352 days）and 4 cases still alive without intestinal obstruction in 2～13 months.Conclusion：Rectal stent may be useful in the management of terminal or high-risk surgical patients for palliative purposes shuning colostomy.Palliation of stent combined with adjuvant chemotherapy by implantation of sustained-releasing 5-fluorouracil can be performed to improve survival.