自膨胀型金属支架治疗晚期结直肠癌合并急性肠梗阻的临床初步研究

Self-expandable metallic stent for advanced colorectal cancer with acute bowel obstruction: a preliminary clinical study

目的:探讨经结肠镜配合X线下置入钛镍记忆合金支架治疗晚期结直肠癌合并急性肠梗阻的安全性与临床疗效。方法:对35例晚期结直肠癌合并急性肠梗阻的患者行永久性支架置入术姑息治疗(支架组),以35例接受传统结肠造瘘手术的同类患者作为对照组,比较两组的手术成功率及临床疗效。结果:支架组放置成功率为100%,并发症发生率为8.57%(术后发生1例肠穿孔,2例支架再梗阻),患者术后即可下床活动,不需人工肛门,随访1年生存率为94.2%;对照组手术成功率100%,并发症发生率为31.42%(术后5例肺部感染,5例切口感染,1例腹腔感染),随访1年生存率为97.1%。两组患者术后肠梗阻均完全缓解,但支架组与对照比较,肠道梗阻缓解迅速,生活质量明显改善,费用更低,并发症发生率低,差异均有统计学意义(均P<0.05)。结论:结肠镜配合X线下置入钛镍记忆合金支架治疗结直肠癌恶性梗阻是一种简单可行、安全有效、并发症少的姑息性治疗手段,能减轻患者痛苦、提高生活质量,并且患者可获得与外科手术相当的生存时间。

Objective： To evaluate the clinical safety and efficacy of Ti-Ni alloy stent placement through colonoscopy combined with X-ray assistance for advanced colorectal cancer with acute bowel obstruction.Methods： h irty-i ve patients with advanced colorectal cancer and acute bowel obstruction underwent palliative treatment by permanent stent placement（stent group）, and 35 patients with the same conditions who were subjected to traditional colostomy served as control group. h e success rate of operation and clinical ef ects of the two groups of patients were compared.Results： In stent group, success rate of stent placement was 100%, incidence of postoperative complications was 8.57%（postoperative intestinal perforation in one case and stent obstruction in two cases）, patients began ambulation immediately at er operation, without creating an artii cial anus, and the survival rate was 94.2 % during 1-year followed-up. In control group, the surgical success rate was 100%, incidence of postoperative complications was 31.42%（postoperative pulmonary infection in 5 cases, wound infection in 5 cases, and abdominal infection in 1 case）, and the survival rate was 97.1% during 1-year followed-up. h e intestinal obstruction was completely resolved in patients of either group after operation, but in stent group compared with control group, the intestinal obstruction was quickly relieved, quality of life was improved, expense was reduced and incidence of complications was decreased and all dif erences had statistical signii cance（all P〈0.05）.Conclusion： Ti-Ni alloy stent placement by colonoscopy combined with X-ray assistance is a safe and ef ective palliative treatment for advanced colorectal cancer with acute bowel obstruction, with the advantages for patients having less suf ering and bet er quality of life, and it also confers to patients a similar survival time as surgical treatment.