记忆合金支架在直肠癌伴梗阻患者中的应用

Shape Memory Alloy Stent for Intestinal Obstruction Due to Rectal Cancer

目的 探讨记忆合金支架治疗直肠癌伴梗阻的疗效及意义。方法 对 2 1例直肠恶性狭窄导致的急、慢性梗阻患者施行了支架置入术。支架在冰水中柔软 ,易压缩 ,通过徒手或乙状结肠镜送至狭窄部位 ,灌注热水后支架复形扩张。结果 18例患者成功置入 ,有效地恢复了排便。 3例置入失败 ,改行结肠造口。带支架的患者中现已死亡 14例 ,生存期5 6～ 72 0天 ;其他 4例已存活 2～ 15个月 ,未再发肠梗阻。结论 记忆合金支架能有效地缓解直肠癌导致的急、慢性梗阻 ,可对晚期直肠癌及有高危手术因素的患者行永久性姑息治疗 ,避免结肠造口。配合化疗和免疫治疗 。

Objective To evaluate initial experience with shape memory alloy stent as an alterative to colostomy in patients with intestinal obstruction of rectal cancer. Methods Twenty one patients with acute and chronic rectal obstructions from malignant causes underwent stent placement. After rectal stent was slenderized in ice water, it was inserted into the strictured rectum by hand or sigmoidoscope. Nitinol mesh stent were deployed in hot water. Results Eighteen patients who had underwent rectal stent placement achieved clinical decompression within 5 hours. Colostomy underwent in 3 patients due to stent failure. Eighteen patients with stent were followed up, 14 cases died in 56-720 days and 4 other cases were still alive without intestinal obstruction in 2-15 months. Conclusion Nitinol mesh stent may be useful in the management of terminal or high risk surgical patients for palliative purposes shuning colostomy. Palliation of stent combined with chemotherapy and immunotherapy can be performed to improve survival.