经内镜支架置入术在左侧结直肠癌梗阻中的应用

Application of Endoscopic Metal Stenting for Left Malignant Colorectal Obstruction

目的探讨经内镜金属支架置入术治疗左侧结直肠癌性梗阻的临床价值。方法在X线透视下经肠镜将导丝插入狭窄近端,沿导丝导入造影管造影了解狭窄情况,根据病变情况选择并放置支架。结果 1例因肠管几乎完全闭塞放弃支架置入,1例因病灶较长而中止支架置入;20例放置支架成功,成功率90.9%,术后1～7 d梗阻症状均得到缓解或消除。2例术后2～3 d粪块堵塞支架,以探条及网篮疏通后缓解;1例术后7 d肿瘤增殖堵塞支架,经肠镜切除后缓解。术后7～10 d限期行肿瘤根治术、一期吻合。结论经内镜放置金属支架治疗左侧结直肠癌性梗阻,能够有效缓解患者的梗阻症状,提高病人的生活质量。

Objective To evaluate the clinical value of endoscopic metal stenting for left malignant colorectal obstruction.Methods Under X-ray observation,the guide wire was inserted to the proximal of obstruction by colonoscopy and an imaging catheter was introduced along the wire to perform radiography. The stent was placed according to the patient ＇s situation. Results The stenting was given up in 1 case because the intestine was completely blocked and in another case because the lesion was too long. Of the 22 patients,metal stents were successfully inserted in 20 patients（ 90. 9%）,and relief of symptoms was obtained within 1- 7 days after operation. Stent occlusion from stool impaction was found in 2 patients 2- 3 days after stent insertion,and was solved by endoscopic interventions. Tumor proliferation involved the stent in 1 patient 7 days after stent insertion,and was treated by endoscopic resection. Radical resections and one stage anastomoses were performed in the 20 patients 7- 10 d after insertion. Conclusion Endoscopic placement of metal stent can effectively relieve symptoms of left malignant colorectal obstruction,with increased patients＇ quality of life.