内镜下支架置入术在治疗结直肠梗阻中的应用

Application of endoscopic colonic stents in treatment of colonic obstruction

目的探讨内镜直视下肠道支架置入治疗结直肠梗阻的临床疗效及意义。方法对2009年3月-2014年3月收治的46例肠梗阻患者实施结肠镜直视下支架置入术,统计一次置入成功率、临床成功率、操作时间、支架留置时间、存活时间、并发症及行外科手术患者术前肠道准备时间、术后住院时间、造瘘率及术后感染率。结果结肠支架一次置入成功率97.8%,单次操作时间5~40 min。21例为结肠癌,其中8例患者梗阻解除后行I期结肠切除术,支架平均留置6 d,无吻合口感染,平均存活28.4个月,其肠道准备时间、术后住院时间及造瘘率、术后感染率均低于结肠癌肠梗阻单纯手术患者;13例结肠癌患者行支架置入姑息治疗,平均支架留置10.7个月,平均存活12.3个月。结肠切除术后吻合口狭窄发生肠梗阻者22例,支架平均留置3 d,截止目前平均存活46.7个月。3例发生并发症（支架移位1例、穿孔2例）,并发症发生率为6.5%。结论肠镜直视下置入结肠支架能够缓解结肠梗阻,具有疗效好、创伤小、操作简便及不良反应少等优点,无论作为长期姑息治疗或过渡性治疗措施均易为临床医师及患者所接受。

Objective To investigate the therapeutic value of endoscopic colonic Methods Data of 46 patients with colonic obstruction who underwent stenting from Mar. stents for colonic obstruction 2009 to Mar. 2014 were retro- spectively analyzed. All the self-expanding metal stents were implanted under colonoscope. One-time success rate of clin- ic, operating time, the stent placement retention time, survival time, complications and so on were recorded. Results Self-expanding metal stents were successfully implanted in 45 patients at the first time, with a high technical success rate of 97.8% （45/46）. One-time operation time was 5 -40 min. Out of the 21 patients with colonic malignant obstruction, stage I primary colonic resection and anastomosis were successfully performed in 8 patients. There was no infection of stoma and mean survival time was 28.4 months. The time of bowel preparation, hospital stay, rate of fistulization and infection were lower than surgery. Stents were implanted in 13 patients as alleviative treatment, the average stent place- ment retention time was 10.7 months, mean survival time was 12.3 months. 22 patients were treated with stenosis of anastomotic stoma, the average stent placement retention time was 3 days, and mean surrival time was 46.7 months. The complication rate was 6.5%. Conclusion Endoscopic implantation of metal stents is effective for colorectal ob- struction as a bridge to surgery or palliative placement, and it is easily accepted by doctors and patients.