摘要
目的探讨经内镜金属支架置入术治疗左侧大肠癌性梗阻的临床价值。方法在X线辅助下经内镜放置支架治疗左侧大肠癌性梗阻患者22例,梗阻部位分别为直肠14例,乙状结肠6例,降结肠2例。结果22例大肠癌性梗阻中,20例放置支架成功,成功率为90.9%,术后1～2d梗阻症状均得到缓解或消除,其中14例为姑息治疗,6例经内镜治疗解除梗阻后7～10d接受外科手术治疗,术后均恢复顺利,无感染及吻合口漏等并发症发生。1例直肠癌术后复发伴盆腔广泛转移者治疗失败,1例乙状结肠癌广泛转移者术中穿孔而急诊行Hartmann术。1例术后6周支架远端移位,导致梗阻复发,置入第2根支架后缓解。1例术后1个月粪块堵塞支架,以探条及网篮疏通后缓解。结论经内镜放置金属支架治疗左侧大肠癌性梗阻,能够有效缓解患者的梗阻症状,该方法操作简单、经济有效、术后并发症少,并可以显著降低患者的创伤和痛苦,提高患者的生活质量。
Objective To appraise the the clinical value of endoscopic metal stenting for malignant left colorectal obstruction. Methods With the aid of fluoroscopy, 22 cases with malignant left colorectal obstruction were treated with endoscopic metal stenting. The obstructive sites were： rectum（n ： 14）, sigmoid colon（n ： 6） descending colon（n：2）. Results Of the 22 patients, 20 were successfully inserted with metal stents （20/22, 90. 9%） , and showed relief of symptoms within 1-2 days. Among them permanent metal stent placement was performed in 14 cases for palliative treatment, 6 underwent subsequent elective surgical resection after 7-10 days without complications of anastomotic leakage and intraperitoneal infection. One case with recurrent rectal carcino- ma after resection pelvic metastasis showed of the operation failed , one case with widespread metastatic sigmoid colon carcinoma had colonic perforation and received immediate Hartmann operation. Recurrent obstruction was present in one patient with distal stent dislocation within 6 weeks, and a second stent was replaced with symptom remission. Stent occlusion from fecal impaction was found in another patient 1 month after stent insertion, and was relieved by endoscpic interventions. Conclusions Endoscopic placement of metal stent can relieve the obstructive symptoms caused by left-sided colonic cancer with high successful rate. It is simple, safe, effective and well tolerable, and can provide pain relief, and increase the patients＇ quality of life. （Shanghai Med J, 2005, 28.. 829-831）
出处
《上海医学》
CAS
CSCD
北大核心
2005年第10期829-831,共3页
Shanghai Medical Journal
关键词
内镜
金属支架
结直肠癌
梗阻
Endoscopy
metal stent
Colorectal Cancer
Obstruction
