透视下金属支架置入术在结肠癌急诊手术中的应用价值

Clinical value of emergent perspective stent implantation for left-side obstructive colonic cancer

目的 探讨透视下金属支架置入术在结肠癌急诊手术中的应用价值.方法 回顾性分析2011年10月至2014年2月东南大学附属徐州医院接受透视下肠道支架置入术治疗26例梗阻性左半结肠癌患者的临床资料.手术采用软硬导丝及导管相互配合操作法,将肠道导丝通过肿瘤狭窄孔,沿肠道导丝将选择好的金属支架及输送器置入并通过狭窄段,释放支架并调整输送器使支架置于目的位置.采用门诊随访,了解患者腹腔引流情况,随访时间截至Ⅰ期手术切除肿瘤后4周.结果 26例患者中病变部位位于直肠9例、乙状结肠10例、降结肠6例、结肠脾曲1例.狭窄长度为2.0～8.0 cm,平均狭窄长度为4.6 cm.26例患者支架置入操作全部成功,全程操作时间为15.2 ～72.0 min,平均操作时间为35.2 min.支架置入时间为2.6 ～ 26.9 min,支架平均置入时间为5.6 min.支架置入术后患者当日排便4～8次,为水样便或稀便.术后10 h即可进流质食物,术后临床症状缓解率为100.0％（26/26）.术中无一例发生穿孔,术后2例患者有轻微出血,经止血药物治疗后好转.26例患者在梗阻症状缓解7～10d行Ⅰ期手术切除肿瘤,手术成功率为100.0％（26/26）.所有患者获得随访,未见切口感染及腹腔引流管引流出粪便样物.结论 透视下金属支架置入术可应用于梗阻性左半结肠癌患者的急诊手术,其方法安全、有效.

Objective To investigate the clinical value of emergent perspective stent implantation for leftside obstructive colonic cancer.Methods The clinical data of 26 patients with obstructive colonic cancer who received emergent perspective stent implantation at the Affiliated Xuzhou Hospital of Southeast University from October 2011 to February 2014 were retrospectively analyzed.A soft and a hard guidewire and a catheter were applied in the operation.The guidewires were put through the hole of the intestinal tumor,and then the metal stent and the conveyor were guided by the guidewires and were pulled through the hole of the intestinal tumor,finally the stent was released and the conveyor was adjusted to ensure that the stent was at the right position.Patients were followed-up through outpatient examination till 4 weeks after tumor resection.Results Of the 26 patients,9 were with rectal cancer,10 with sigmoid colonic cancer,6 with descending colonic cancer,1 with splenic flexure cancer.The median length of stenosis was 4.6 cm （range,2.0-8.0 cm）.The surgery of the 26 patients was successful.The mean operation time was 35.2 minutes （range,15.2-72.0 minutes）,and the mean time of stent implantation was 5.6 minutes （range,2.6-26.9 minutes）.Patients had watery or loose stool for 4-8 times after stent implantation.Ten hours after the operation,all the patients were given liquid diet.The remission rate of clinical symptoms was 100.0％ （26/26）.No colonic perforation was detected during the operation.Two patients were complicated with slight bleeding,and was alleviated by medication.Twenty-six patients received stage Ⅰ tumor resection procedure within 7-10 days after the symptoms of intestinal obstruction were remised.The success rate of surgery was 100.0％ （26/26）.No infection and other drainage were detected after tumor resection through follow-up.Conclusion Emergent perspective stent implantation for left-side obstructive colonic cancer is safe and effective.