目的探讨内支架治疗直肠乙状结肠癌并肠梗阻的方法和效果。方法对内科治疗无效的直肠乙状结肠癌并肠梗阻患者在X线和电子结肠镜下置入金属内支架,观察疗效及并发症。结果共治疗20例,男16例,女4例。年龄27～78岁,平均59.21岁。直肠癌14例,乙状结肠癌2例,乙状结肠癌术后复发并腹腔转移4例。成功率:14例直肠梗阻均一次性支架置放成功,成功率100%。6例乙状结肠梗阻一次性置放成功4例,1例首次置放国产支架失败,后改放进口支架成功,1例失败,成功率83.33%。总成功率95.00%。效果:支架置放后立即见粪便涌出,24小时所有支架置放成功,患者肠梗阻症状缓解,24小时后均恢复进食,术后3天复查X线平片肠梗阻均好转,短期有效率100%。12例术后3～7天行肠道准备后外科手术治疗,11例行I期手术根治术,术后未出现感染、吻合口漏等并发症;1例术中发现广泛转移行开关手术。4例患者因结肠癌术后复发并腹腔转移行支架永久性姑息治疗;3例因重要器官功能障碍无法耐受外科手术行支架永久性姑息治疗。8例永久性支架治疗患者随访,1例患者术后36天出现肠梗阻症状复发,CT考虑支架阻塞,行外科手术,术后5天死于心衰。1例患者于术后62天出现肠梗阻症状,CT示腹腔广泛转移至其他部位肠梗阻死亡。1例患者于术后80天死于全身衰竭。另5例患者随访90～180天,支架保持通畅,病人情况良好。并发症:1例患者手术后出现便血加重,经药物治疗1周后好转。未出现其他并发症。结论在内镜联合X线下金属支架置入治疗直肠乙状结肠癌并肠梗阻成功率高,安全,短期效果明显。 Objective To investigate the method and effect of stent treatment for rectosigmoid colon cancer with intestinal obstruction. Methods In patients with rectosigmoid colon disease and intestinal obstruction who were ineffective in medical treatment, metal stent was placed under X-ray and electronic colonoscopy to observe the curative effect and complications. Results A total of 20 cases were treated, 16 males and 4 females. Aged 27 to 78 years old, with an average of 59.21 years old. 14 cases of rectal cancer, 2 cases of sigmoid colon cancer, sigmoid colon cancer recurrence and abdominal metastasis in 4 cases. Success rate: 14 cases of rectal obstruction were placed in one-time stent success, the success rate of 100%. Six cases of sigmoid colon obstruction were successfully placed in one time. In the first case, the stent failed to be placed in the first place in China. After the stent was changed, the stent was successfully replaced. One case failed with a success rate of 83.33%. Assembly success rate of 95.00%. Results: Immediately after placement of the stent, excrement was ejected, and all stent placement was successful in 24 hours. All patients were relieved of intestinal obstruction and re-fed after 24 hours. All cases were rechecked for X-ray plain obstruction 3 days after operation, and short-term effective rate 100%. Twelve cases underwent surgery for intestinal surgery 3 to 7 days after surgery, and 11 cases underwent radical surgery. There were no complications such as infection and anastomotic leakage after surgery. One case was found to have widespread metastatic switch. Four patients had permanent palliative care due to recurrence of colon cancer and peritoneal metastasis. Three patients were unable to tolerate permanent palliative treatment with surgical stents due to vital organ dysfunction. Follow-up was performed on 8 patients with permanent stent. One patient had recurrence of intestinal obstruction 36 days after operation. CT considered stent occlusion and underwent surgical operation and died of heart failure 5 days after operation. One patient showed symptoms of intestinal obstruction at 62 days postoperatively, CT showed extensive abdominal cavity metastasis to other parts of intestinal obstruction. One patient died of systemic failure 80 days after surgery. The other 5 patients were followed up for 90 to 180 days, the stent remained open and the patient was in good condition. Complications: One patient had hematochezia aggravated after operation and improved after one week of drug treatment. No other complications occurred. Conclusions The success rate of metal stent implantation under endoscopic combined with X-ray for the treatment of rectosigmoid colon cancer is high, and the safety and short-term effect are obvious.