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内镜支架置入术在缓减晚期胃癌患者结肠阻梗方面不如急性外科一样有效

发布日期:2014-1-29 12:40:25 文章来源:GIE 作者次数:1025
    内镜支架置入术在缓减晚期胃癌患者结肠阻梗方面不如急性外科一样有效

    背景

    虽然已证明自膨式金属支架(SEMS)植入术是一种缓减结肠恶性肿瘤所致梗阻的有效疗法,但是还未有对其在减缓结肠外恶性肿瘤(ECM)所致梗阻方面的临床疗效进行广泛评估。

    目的      

    本研究的目的是评估SEMSs的临床效果与并发症,并与采用急诊外科治疗晚期胃癌(AGC)患者结肠梗阻的结果相比较。

    设计

    回顾性研究。

    患者

    20001月至200912月,本研究纳入的为缓减结肠恶性阻梗晚期胃癌患者包括采用SEMSs治疗的111例,或采用急诊外科治疗的69例。

    干预

    SEMS植入或外科治疗。

    结果

    虽然SEMS急性并发症和形成造口发生率低于外科组,但它的临床疗效不如急性外科(技术成功73.9%和94.2%,P = 0.001;临床成功率为54.1%和75.4 %,P = 0.005)。SEMS相关并发症发生率为64.5%,包括再梗阻(36.8%),支架移位(10.5%),穿孔(13.2%),出血(3.9%)。接受SEMS植入患者与接受急诊外科患者的通畅中位数没有统计学差异,它们分别为117天和183天,P=0.105。內镜支架植入后,其中小于2个阻梗部位的患者或者阻梗发病时间不到2年的患者取得较好的临床疗效。

    局限性

    一项回顾性单中心研究

    结论

    SEMS植入对缓减晚期胃癌患者结肠阻梗的效果比急诊外科低。故还需进行进一步研究,以此确定SEMS植入对结肠外恶性肿瘤(ECM)患者可能有益。

    缩写词:AGC,晚期胃癌;CRC,结肠癌;ECM,结肠外恶性肿瘤;SEMS,自膨式金属支架。

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    Endoscopic stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery

    Background

    Although self-expandable metal stent (SEMS) insertion has been shown to be an effective therapy for palliation of obstruction from colorectal malignancy, the clinical efficacy of SEMS insertion in the palliation of colorectal obstruction from an extracolonic malignancy (ECM) has not been extensively evaluated.

    Objective

    The aim of this study was to evaluate the clinical outcomes and complications of SEMSs compared with those of emergency surgery for relief of colorectal obstruction in patients with advanced gastric cancer (AGC).

    Design

    Retrospective study.

    Patients

    From January 2000 to December 2009, patients with AGC who were treated with SEMSs (N = 111) or emergency surgery (N = 69) for palliation of malignant colorectal obstruction were included.

    Intervention

    SEMS insertion or surgery.

    Results

    Although acute complications and stoma formations were lower in the SEMS group than in the surgery group, the clinical efficacy of SEMSs was inferior to emergency surgery (technical success, 73.9% vs 94.2%, P = .001; clinical success, 54.1% vs 75.4%, P = .005). SEMS-related complications occurred in 64.5%, including reobstruction (36.8%), stent migration (10.5%), perforation (13.2%), and bleeding (3.9%). The median duration of patency was not statistically different between the patients who underwent SEMS insertion and those who underwent emergency surgery (117 days vs 183 days, P = .105). Patients with fewer than 2 obstructive sites or less than 2 years to obstructive symptom onset after diagnosis of AGC showed better clinical outcomes after endoscopic stenting.

    Limitations

    Retrospective and single-center study.

    Conclusions

    SEMS insertion seems to be less effective than emergency surgery for the palliation of colorectal obstruction in patients with AGC. Further study is necessary to define those patients with ECM who may benefit from SEMS insertion.

    Abbreviations:  AGC, advanced gastric cancer, CRC, colorectal cancer, ECM, extracolonic malignancy, SEMS, self-expandable metal stent

     

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