摘要
目的探讨急诊肠道支架置入对结直肠癌所致急性肠梗阻的临床效果。方法收集2014年至2018年湖南省3家三级医院收治的因结直肠癌导致急性肠梗阻采用肠道支架置入术的37例患者的临床资料,其中中南大学湘雅三医院16例,怀化市第一人民医院11例,湖南医药学院第一附属医院10例。所有患者全部选择经结肠镜置入肠道支架至梗阻部位后限期行手术或保守治疗。结果37例患者中,1例患者因行肠镜时出血较多而行急诊手术;其余36例患者全部成功行内镜下结肠支架置入术,均一次放置成功,其中1例患者术后3d仍未排气、排便,腹痛加剧,腹部立位平片提示膈下游离气体,遂行急诊手术;1例患者术后5d发生支架移位后再次行支架置入;其余患者术后第2天开始进食水,无不适或不能耐受支架者。未再出现穿孔、消化道出血及腹痛等并发症者。支架放置时间30~90min,平均40min;支架置入术成功率为97.3%,临床成功率为94.3%。梗阻症状逐渐缓解后选择二期手术16例,选择保守治疗19例。随访6~48个月,行二期手术的16例患者中,有3例因肿瘤分期较晚,术后未遵医嘱行放化疗而出现肿瘤复发,其余13例均未出现肿瘤转移或复发情况;选择保守治疗的19例患者中,13例患者因肿瘤多发转移死亡,其余6例仍在随访中。结论结直肠癌所致急性肠梗阻行急诊内镜放置肠道支架是安全有效的,可变急诊手术为平诊手术,明显降低患者病死率及造瘘率,对晚期姑息治疗的患者亦是一种安全、简便的治疗方式,可提高其生活质量。
Objective To investigate the clinical effects of emergency intestinal stent placement on acute intestinal obstruction caused by colorectal cancer. Methods The clinical data of 37 patients with acute intestinal obstruction caused by colorectal cancer in 3 tertiary hospitals in Hunan Province from 2014 to 2018 were collected. Among them, 16 cases were from Xiangya Third Hospital of Central South University, 11 cases from the First People’s Hospital of Huaihua, and 10 cases from the First Affiliated Hospital of Hunan University of Medicine. All patients were selected for colonoscopy or stenting after the colonoscopy. Results Among the 37 patients, 1 patient underwent emergency operation because of more bleeding during enteroscopy. All the other 36 patients underwent endoscopic colon stenting. All stents were successfully placed at one time. One of the patients had not vented and defeated for three days after surgery, and the abdominal pain was aggravated. The plain film of the abdomen indicated the free gas under the armpit in the patient, so the emergency operation was performed. Another 1 patient had stent placement again 5 days after operation for displacement;and the other patients started feeding water on the next day after surgery, without any discomfort or intolerance to the stent. There were no complications such as perforation, gastrointestinal bleeding and abdominal pain. The stent placement time was 30 to 90 minutes, with an average of 40 minutes. The success rate of stent placement was 97.3%, and the clinical success rate was 94.3%. After obstructive symptoms were gradually relieved, 16 patients underwent secondary surgery, 19 patients underwent conservative treatment. During the follow-up of 6 to 48 months, 3 of 16 patients who underwent secondary surgery had late tumor stage, and tumor recurred for without radiotherapy and chemotherapy which was not in accordance with medical advice. The other 13 patients who underwent second-stage surgery after removal of the colonic stent had no tumor metastasis or
作者
欧飞
姚敦武
杨泉波
蒲辉
陈光谱
Ou Fei;Yao Dunwu;Yang Quanbo;Pu Hui;Chen Guangpu(Department of General Surgery,the First Affiliated Hospital of Hunan University of Medicine,Huaihua 418000,China)
出处
《中国实用医刊》
2019年第17期33-36,共4页
Chinese Journal of Practical Medicine
关键词
自膨式金属支架
急性肠梗阻
急诊内镜
姑息治疗
Self-expanding metal stent
Acute intestinal obstruction
Emergency endoscopy
Palliative treatment
