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结直肠金属支架置入术对左半结肠癌所致肠梗阻的治疗价值

(2014-10-22 12:28:57)

    结直肠金属支架置入术对左半结肠癌所致肠梗阻的治疗价值

    陈婧 张杰 张瑾芬 武沪平 郝建宇

    作者单位:100020 北京,首都医科大学附属北京朝阳医院消化内科

    【摘要】目的 探讨结直肠金属支架置入术对左半结肠癌所致肠梗阻的治疗价值。方法 20075月至20115月因左半结肠癌肠梗阻接受结直肠金属支架置入术的29例患者的病例资料进行回顾性分析。结果 27例成功进行支架置入术,腹胀、呕吐症状缓解,2例由于病变肠段较长,高度水肿,完全阻塞肠腔,导丝无法通过而未成功,支架置入成功率92.6%27/29)。置入支架的27例中24例成功进行了Ⅰ期左半结肠切除无张力吻合术,术中发现支架穿透肠壁1例(1/273.7%),手术后好转,围手术期无死亡病例发生,平均住院天数11.7 d3例未接受手术治疗者支架通畅时间平均为5个月。结论 对于左半结肠癌所致肠梗阻,金属支架置入术可有效解除梗阻,并作为过渡治疗,利于手术前进行充分的肠道准备,为择期行外科肿瘤根治术创造条件。

    【关键词】金属支架 恶性结肠病变 肠梗阻

    Therapeutic value of endoscopic metal stent implantation for left-sided malignant colorectal obstruction CHEN Jing, ZHANG Jie, ZHANG Jin-fen, WU Hu-ping, HAO Jian-yu Department of Gastroenterology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China

    Corresponding author: ZHANG Jie, Email: zhangjie4155@sina.com

    Abstract Objective To investigate the therapeutic value of endoscopic implantation of metal stents for obstruction caused by left-sided malignant colorectal tumor. Methods Data of 29 patients with left-sided malignant colonic obstruction who underwent stenting from May 2007 to May 2011 were retrospectively analyzed. Results Self-expanding metal stents were successfully implanted in 27 patients. Symptoms of abdominal distention and vomiting subsided in these patients. The procedure failed in 2 patients (2/29),  because the guidewire  failed to pass the colonic stricture due to edema and the length of the diseased colon. Technical success was achieved in 27 of total 29 patients (27/29, 92.6%). Out of the 27 patients, stage primary left-sided colonic resection and anastomosis were successfully performed in 24 patients. Colonic perforation was found intraoperatively in 1 patient (1/27, 3.7%) who subsequently recovered after operation. There was no death during the perioperative period with the average hospital stay of 11.7 days. A mean colonic stent patency for 5 months was observed in 3 patients who underwent palliative stenting only. Conclusion Endoscopic implantation of metal stents is effective for  left-sided malignant colorectal obstruction. As a bridge to surgery, it facilitates sufficient bowel preparation for elective radical operation.

    Key wordsMetal stent; Malignant colonic disease; Bowel obstruction

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个人资料
    郝建宇 单位:首都医科大学附属北京朝阳医院
    所属科室:
    出生:1967-03-17
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