结肠癌并发肠梗阻经内镜支架置入术临床应用及精细化操作

The clinical application and refinement operation of endoscopic stent implanation for colonic carcinoma complicated with intestinal obstruction

目的探讨结肠癌并发肠梗阻经内镜支架置入术后的临床应用,通过精细化操作,提高支架置入成功率,减少并发症。方法收集整理滨州医学院附属医院;淄博矿业集团有限责任公司中心医院2016年1月至2017年8月诊治的结肠癌并发肠梗阻患者26例,其中,男14例、女12例,年龄38~67岁,平均年龄(53.6±3.6)岁。均在X线透视下经内镜置入支架,成功解除梗阻后进行后续治疗。结果 25例患者经内镜成功放入支架,梗阻症状均得到有效缓解或消失,未发生支架脱落、肠道穿孔、大量出血等并发症;1例患者因肠道完全梗阻,导丝不能通过而放弃支架置入。19例患者7~10 d后行腹腔镜下结肠癌根治切除术、6例患者因肿瘤不能手术切除而行永久性内置支架姑息性治疗。结论通过内镜支架置入术的术前精细准备及术中细致化操作,可以有效避免并发症的发生,为进一步外科手术治疗创造条件,提高患者术后生存率及生活质量。

Objective To explore the clinical application of colonic endoscopic stent implantation and to improve the success rate of implantation and reduce complications by refining the operation. Methods Data of 26 patients with colon cancer complicated by obstruction diagnosed and treated from January 2016 to August 2017 in our hospital were collected, both via endoscopic stent placement under X-ray fluoroscopy. The obstructions were successfully removed for subsequent treatment. Results Twenly-five patients were successfully put into the stent under endoscope, and the symptonls of obstruction were effectively alleviated or disappeared. The patients had no stent loss, intestinal perforation, bleeding and other complications. The intestine of one patient failed to pass the stent implantation because of a complete obstruction of the intestinal tract. In the 19 cases, patients with a laparoscopic radical resection of colon cancer were performed on 7-10 d afler laparoscopic surgery, and 6 patients were treated with permanent stents for nonsurgical resection of the tumors. Conclusion Preoperative careful preparation and intraoperative careful operation of endoscopic stent implantation can effectively avoid the complications, making chances for furlher surgical treatments, improving postoperative survival rate and patients＇ quality of life.