内镜下置入金属支架治疗近端结肠癌导致恶性梗阻的疗效观察

摘要

目的 观察结肠镜下金属支架置入术治疗近端结肠癌导致狭窄的疗效. 方法 回顾性分析我科2004年1月～2011年3月8例X线引导下结肠镜下金属支架置入术治疗的近端结肠癌导致狭窄的临床资料,男3例,女5例,年龄45 ～79岁,(67.2±11.3)岁.升结肠癌3例,结肠肝曲癌4例,横结肠癌1例.均有腹痛、腹胀等表现,从就诊到接受结肠支架置入术的中位时间6 d(1～22 d).术前腹部CT或腹部乎片提示肠管明显扩张7例.8例肠管扩张最宽处直径30 ～ 96mm,(62.7±20.3)mm. 结果 术后住院时间3～18d,(9.0±4.8)d.术后症状均明显缓解.术后第1～2天复查,肠管最宽处直径30～ 45 mm,(33.6±5.6)mm,较前明显缓解(P =0.003).未见穿孔、出血等并发症.1例术后5天支架移位.术后2例失访,2例支架置入后手术切除局部肠管一期吻合者随访9、23个月仍存活,4例死亡,死亡时间为置入支架后1、3、5、15个月. 结论 近端结肠癌导致恶性梗阻与远端结肠一样,均可进行内镜下金属支架置入术,疗效满意,并且影像学发现肠腔狭窄,即使无肠管明显扩张者亦可进行结肠支架置入术,改善患者症状,提高生活质量.%Objective To observe the efficacy of endoscopic stenting for proximal colonal obstruction caused by malignant lesion. Methods A total of 8 patients [3 men and 5 women, 45 -79 years old with a mean of (67. 2 ±11.3) years] , who received X-ray-guided endoscopic stenting from January 2004 to March 2011, were enrolled into this retrospective analysis. In the patients, the tumor was detected in the ascending colon in 3 cases, at the hepatic flexure in 4, and in the transverse colon in the other one. All the patients complained of abdominal pain and distension. The medium time from the first visit to our hospital to endoscopic stenting was 6 days (ranged from 1 to 22 days) . Before the stenting, abdominal CT or KUB showed expansion of the bowel in 7 of the patients. The biggest diameter of the expanded colon was (62. 7 ± 20. 3) mm (range from 30 to 96). Results The mean postoperative hospital stay in this series was (9.0 ±4.8) days ( ranged 3-18 days). Re-examination on the first or second day showed that the colonal expansion was improved significantly, the biggest diameter dropped to (33.6 ±5.6) mm (ranged from 30 -45 mm, P-0.003). No perforation of hemorrhage occurred after the endoscopic stenting. In one patient, the stent dislocated at day 5 after the procedure. Two patients was lost to follow-up, in the other 6 patients, 4 patients died in 1 , 3 , 5 , or 15 months after stenting, respectively; the other two, who underwent partial resection of the colon and primary anastomosis after stenting, survived by the end of follow-up (9 and 23 months after stenting respectively). Conclusions Same as distal colonal cancer, malignant obstruction caused by proximal eolonal lesion can be managed with endoscopic stenting too. The procedure can be made on patients with bowel stricture, even without evident colonal expansion. It is an effective method to improve the symptoms and life quality of patients with malignant obstruction of the proximal colon.