自膨式金属支架治疗结直肠癌患者肠梗阻的价值

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摘要目的探讨结肠自膨式金属支架在梗阻性结直肠癌治疗中的临床应用价值及并发症的相关危险因素。方法回顾性分析空军特色医学中心2014-09至2019-12临床诊断结直肠癌伴梗阻行肠道自膨式金属支架置入术患者的临床资料40例,并进行术后随访,总结支架放置的技术成功率、梗阻的短期缓解率及长期效果、并发症,根据术后1周内有无并发症将患者分为并发症组(10例)和无并发症组(30例),分析并发症发生的相关危险因素。结果 40例结直肠癌伴梗阻患者行金属支架置入术,技术成功率100.00%,临床有效率97.50%。支架放置7 d内并发症发生率为25.00%(10/40),其中轻症并发症7例(17.50%),分别为感染5例、出血2例;严重并发症3例(7.50%),分别为迟发穿孔2例、支架移位1例。并发症组患者平均年龄高于无并发症组(P=0.015),发生梗阻时间并发症组(15.40±11.19)d长于无并发症组(8.20±8.13)d(P=0.034),并发症组表现为完全性肠梗阻的比例明显高于无并发症组(60.0% vs. 16.7%,P=0.025),并发症组镜下狭窄程度构成比例与无并发症组相比也有统计学差异,并发症组以管腔完全堵塞为主(P=0.025)。结论自膨式金属支架可以快速解除梗阻,是结直肠癌患者肠梗阻较为安全且有效的治疗方法,但对于高龄、梗阻病程长及梗阻程度严重的患者,需警惕术后出现感染及穿孔等并发症。

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	李静
	张燕双
	徐梦楠
	张静
	李白容
	宁守斌
	顾国利

关键词 ：自膨式金属支架, 结直肠癌, 梗阻, 穿孔, 并发症

Abstract：Objective To explore the applicability of self-expanded metal stents in the management of obstruction caused by colorectal cancer.Methods The clinical data on forty patients who received stent insertion for malignant colorectal obstruction at our center between September 2014 and December 2019 was retrospectively analyzed. These patients were divided into the complication group and the non-complication group according to the occurrence of complications within one week after surgery. They were closely followed up after treatment, and the last follow-up date was April 8, 2020.Results The technical and clinical success rates of stenting were 100.00% and 97.50% respectively. Complications occurred in 25.00% (10/40) of these patients, including 7 cases (17.50%) of minor complications and 3 cases of (7.50%) serious complications (2 cases of delayed perforation and 1 case of stent displacement). The average age of patients in the complication group was significantly above that of the non-complication group[(79.50±11.79)y vs. (67.17±13.66)y, P=0.015]. The duration of obstruction in the complication group was significantly longer than that in the non-complication group[(15.40±11.19)d vs. (8.20±8.13)d, P=0.034]. The incidence of complete intestinal obstruction in the complication group was significantly higher than that in the non-complication group (60.00% vs. 16.67%, P=0.025). More cases showed complete lumen occlusion in the complication group than in the non-complication group (P=0.025).Conclusions This study shows that the self-expanded metal stent is safe and effective for relieving obstruction in patients with malignant colorectal cancer. However, clinicians need to be vigilant against postoperative complications such as infection and perforation among patients of advanced age or with chronic obstruction or complete intestinal obstruction.

Key words： self-expanded metal stent colorectal cancer obstruction perforation complication

收稿日期: 2020-04-30

ZTFLH:

R574.2

通讯作者: 宁守斌,E-mail:ning-shoubin@163.com

作者简介: 李静,博士,副主任医师。

引用本文:

李静, 张燕双, 徐梦楠, 张静, 李白容, 宁守斌, 顾国利. 自膨式金属支架治疗结直肠癌患者肠梗阻的价值[J]. 武警医学, 2020, 31(8): 683-687. LI Jing, ZHANG Yanshuang, XU Mengnan, ZHANG Jing, LI Bairong, NING Shoubin, GU Guoli. Applicability of self-expanded metal stents in the treatment of obstruction in colorectal cancer. Med. J. Chin. Peop. Armed Poli. Forc., 2020, 31(8): 683-687.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2020/V31/I8/683

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