自膨式金属支架治疗肠外肿瘤所致急性结直肠梗阻临床价值研究

Comparison of self-expandable metallic stent placement for acute colorectal obstruction caused by extracolonic malignancy and colorectal cancer

目的评估自膨式金属支架(self-expendable metallic stent,SEMS)置入治疗由肠外肿瘤(extracolonic ma-lignancies,ECM)所致的急性结直肠梗阻(acute colorectal obstruction,ACO)的安全性、有效性及其预后。方法复旦大学附属中山医院将2006年11月至2012年4月收治的109例恶性ACO病人纳入研究,其中已出现转移或术后复发的结直肠癌(colorectal cancer,CRC)病人96例,ECM病人13例,比较两组的成功率、并发症发生率与存活时间。结果 ECM组中胃癌8例(61.5%)、妇科肿瘤3例(23.1%)、膀胱癌1例(7.7%)、盆腔炎性纤维母细胞瘤1例(7.7%)。两组SEMS置入成功率均为100%,在临床缓解率方面差异无统计学意义(77.0%vs.83.3%,P=0.696)。在支架通畅时间方面差异无统计学意义(117±148.8vs.188.2±203.6,P=0.230)。ECM组的SEMS相关并发症为再梗阻2例和支架移位1例。1例SEMS置入后症状未缓解。两组间在30d病死率、1年存活率和总体存活率方面差异均无统计学意义(P=1.000,P=0.140,P=0.282)。结论 SEMS置入治疗由ECM所致ACO的安全性、有效性及预后与其条件相似的CRC所致ACO相近。SEMS置入是治疗恶性ACO的一个合适选择。

Objective To evaluate the safety, efficacy and prognosis of self-expendable metallic stent （SEMS） placement in patients with acute colorectal obstruction （ACO） caused by extracolonic malignancies （ECM）. Methods One hundred and nine cases of ACO admitted between November 2006 and April 2012 in Zhongshan Hospital of Fudan University were analyzed. The cases caused by metastatic or recurrent colorectal cancer （CRC） （n = 96） were compared with the cases caused by ECM （n = 13） in success rate,complications and survival time. Results ECM group included 8 cases of gastric cancer（61.5%）, 3 cases of gynecologic cancer（23.1%）, 1 case of bladder cancer （7.7%）and 1 case of pelvic inflammatory fibroblastic tumor （7.7%）. The technical success rate was 100% in both ECM group and CRC group. The clinical remission rate was not significantly different between the two groups （77.0% vs. 83.3%, P = 0.696）. The stent patency time was also similar between the two groups （117.0 ± 148.8 vs. 188.2 ± 203.6, P =0.230）. Stent related complications in ECM group included 2 cases of reobstrucfion and 1 case of migration. Symptom was not relieved in 1 case performed SEMS placement. There were not significantly difference in 30-day mortality, 1-year survival rate and overall survival rate between two groups （P= 1.000, P= 0.140, P= 0.282）. Conclusion The safety and effectiveness of SEMS placement in patients with ACO caused by ECM are comparable to that in patients with ACO caused by metastatic or recurrent CRC. It may be an appropriate option for treating malignant ACO.