内镜下肠道金属支架置入术在结直肠恶性梗阻中的近期疗效评估

Short-term safety and efficacy of endoscopic self-expandable metal stent implantation for malignant colonic obstruction

目的探讨内镜下肠道金属支架（SEMs）置入术在结直肠恶性梗阻治疗中的近期疗效和安全性。方法纳入2012年1月至2014年5月盛京医院内镜诊治中心收治的因结直肠恶性梗阻行内镜下SEMs置人术的患者208例，整理回顾该技术的技术成功率、临床成功率及短期并发症发生情况并行分析。结果全部患者中，SEMs置入的技术成功率为99．04％（206／208），临床成功率为96．15％（200／208）。术后并发症以腹痛、穿孔和出血为主，腹痛的发生率为13．46％（28／208），除并发穿孔外，均可自行缓解；穿孔发生率为2．88％（6／208），均行急诊外科手术治疗；出血发生率为1．92％（4／208），除1例腹腔内出血行急诊手术治疗外，均自行缓解。结论SEMs置人术的手术成功率高，可以有效缓解结直肠恶性梗阻，不仅可以作为外科手术的桥梁，还可作为姑息性治疗的手段，提高患者生存质量，临床上值得推广。

Objective To evaluate the short-term safety and efficacy of endoscopic implantation of self-expandable metallic stent （SEMs） for malignant colorectal obstruction. Methods A total of 208 pa- tients who had undergone endoscopic SEMs implantation for malignant colonic obstruction from January 2012 to May 2014 at the endoscopy center of Shengjing hospital were enrolled. The technical and clinical success rate and the complications were reviewed. Results The technical and clinical success rates were 99.04% （ 206/208 ） and 96. 15% （200/208）, respectively. Abdominal pain, perforation and bleeding were the most common post-procedure complications, the rates of which were 13.46% （ 28/208 ）, 2. 88% （ 6/208 ）, 1.92% （4/208）, respectively. The abdominal pain in most patients was self-relieving except for 6 patients with perforation of colon. Patients with perforation were cured by emergency surgery. One patient with intrap- eritoneal hemorrhage was also cured by emergency surgery, the other patients developing bleeding recovered themselves. Conclusion The success rate of endoscopic SEMs implantation is satisfactory in the study. As a bridge to surgery or a palliative care method, endoscopic SEMs implantation is effective and safe for malig- nant colorectal obstruction.