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目的:探讨内镜引导下金属支架置入术治疗结直肠癌并发急性肠梗阻的可行性及临床效果。方法:对20例结直肠癌并发急性肠梗阻的患者,在内镜引导下行金属支架置入术,然后观察其临床效果。其中乙状结肠癌11例,降结肠癌4例,直肠癌5例,术前评估可切除的结直肠癌15例,结肠癌并腹腔转移5例。结果:20例患者金属支架置入一次成功19例,1～2d后梗阻症状均消除或缓解,7～10d后15例可切除的结直肠癌行肠管Ⅰ期切除吻合术,术后恢复顺利,无感染及吻合口漏等并发症;4例因肿瘤转移行永久性支架植入术。随访90～180d,1例于术后51d肠梗阻症状复发,再行外科手术死于心功能衰竭;1例因癌细胞转移,术后83d死于全身衰竭。1例患者在术后42d出现内支架移位,置入了第2根支架后症状缓解。结论:经内镜引导下置入金属内支架治疗结直肠癌并发肠梗阻成功率高,安全、经济,明显减轻患者痛苦,提高患者的生活质量。
Objective: To investigate the feasibility and clinical effect of endoscopic stenting with metal stent in the treatment of colorectal cancer with acute intestinal obstruction. Methods: Twenty patients with colorectal cancer complicated with acute intestinal obstruction underwent endoscopic stenting with metal stents, and then observed its clinical effect. Among them, there were 11 cases of sigmoid colon cancer, 4 cases of descending colon cancer and 5 cases of rectal cancer. There were 15 cases of resectable colorectal cancer, 5 cases of colorectal cancer and peritoneal metastasis. Results: Twenty patients were successfully treated with metal stent in 19 cases. Obstruction symptoms were eliminated or alleviated after 1 ~ 2 days. Fifteen resectable colorectal cancer patients underwent stage Ⅰ resection and anastomosis 7 to 10 days after operation, No infection and anastomotic leakage complications; 4 cases of tumor metastasis due to permanent stent implantation. At follow-up of 90 to 180 days, one case developed symptoms of intestinal obstruction 51 days after operation and died of heart failure after surgery. One case died of systemic failure after 83 days of operation due to the metastasis of cancer cells. One patient had internal stent displacement 42 days after operation, and the symptom was relieved after the insertion of the second stent. CONCLUSION: The success rate of colorectal cancer complicated with intestinal obstruction treated with endoscopic stent implantation is high, safe and economical, and significantly reduces the pain of patients and improves the quality of life of patients.