切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (03) : 277 -282. doi: 10.3877/cma.j.issn.2095-3224.2020.03.012

所属专题: 文献

论著

使用刚性引导技术行支架置入术治疗结直肠癌梗阻的疗效分析
许琳惠1, 任建庄1,(), 段旭华1, 陈鹏飞1, 张文广1, 万里1, 王家兴1, 邝东林1, 李方正1, 韩新巍1   
  1. 1. 450052 郑州大学第一附属医院放射介入科
  • 收稿日期:2019-11-04 出版日期:2020-06-25
  • 通信作者: 任建庄
  • 基金资助:
    河南省高等学校重点科研项目计划(No.19A320057)

The efficiency of using the stiff guidance technique in stent placement for treating the colorectal cancer obstruction

Linhui Xu1, Jianzhuang Ren1,(), Xuhua Duan1, Pengfei Chen1, Wenguang Zhang1, Li Wan1, Jiaxing Wang1, Donglin Kuang1, Fangzheng Li1, Xinwei Han1   

  1. 1. Interventional Radiology Department, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
  • Received:2019-11-04 Published:2020-06-25
  • Corresponding author: Jianzhuang Ren
  • About author:
    Corresponding author: Ren Jianzhuang, Email:
引用本文:

许琳惠, 任建庄, 段旭华, 陈鹏飞, 张文广, 万里, 王家兴, 邝东林, 李方正, 韩新巍. 使用刚性引导技术行支架置入术治疗结直肠癌梗阻的疗效分析[J/OL]. 中华结直肠疾病电子杂志, 2020, 09(03): 277-282.

Linhui Xu, Jianzhuang Ren, Xuhua Duan, Pengfei Chen, Wenguang Zhang, Li Wan, Jiaxing Wang, Donglin Kuang, Fangzheng Li, Xinwei Han. The efficiency of using the stiff guidance technique in stent placement for treating the colorectal cancer obstruction[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(03): 277-282.

目的

探讨使用刚性引导技术行金属支架置入术治疗结直肠癌梗阻的可行性及临床疗效。

方法

回顾性分析2014年1月至2018年9月收治的77例结直肠癌梗阻患者的临床资料,记录使用刚性引导技术行金属支架置入术的操作时间、术后24 h脐水平的腹围缩小程度、术后腹胀缓解时间、术后不良反应,分析技术成功率,临床成功率和并发症。

结果

77例结直肠癌梗阻的患者共置入金属支架85枚,技术成功率100%,手术时间30~240(中位50)min,其中6例患者置入2枚金属支架,1例患者置入3枚金属支架。患者术前测量脐水平的腹围为(107.8±12.1)cm,术后24 h降至(83.9±8.2)cm,缩小程度为(23.4±11.2)cm,术后中位腹胀缓解时间为1.9 d(1~6 d)。肠梗阻症状完全治愈62例(80.5%),症状改善9例(11.7%),症状无改善6例(7.8%),临床成功率为93.5%。3例(3.9%)患者出现腹痛症状,1例(1.3%)患者出现少量便血,无患者发生支架移位。26例患者于金属支架置入术后5~14 d行外科手术治疗,出现伤口感染1例,无肠漏、肠梗阻并发症;51例姑息性治疗患者支架通畅率1个月时为92.2%,3个月时为84.7%,6个月时为68.4%,12个月时为46.9%。

结论

数字减影血管造影技术(DSA)下金属支架置入术是治疗结直肠癌梗阻的一种安全有效的治疗措施,同时采用刚性的引导技术可提高技术成功率。

Objective

To investigate the feasibility and clinical efficacy of rigid technique in the treatment of colorectal cancer obstruction with metal stent.

Methods

Retrospective analysis of the clinical data of 77 patients with colorectal cancer obstruction admitted from January 2014 to September 2018, record the operation time of metal stent placement using rigid guiding technique, measure the degree of abdominal circumference reduction at 24 hours postoperatively, postoperative bloating relief time, postoperative adverse reations, analysis technique success rate, clinical success rate and complications.

Results

Seventy-seven patients with colorectal cancer obstruction were implanted with 85 metal stents, with a technical success rate of 100% and an operation time of 30~240 minutes (median 50 minutes), among which six patients were implanted with two metal stents, and one patient was placed with three metal stents. The abdominal circumference of the patient before the measurement of the umbilical level was (107.8±12.1) cm, and it decreased to (83.9±8.2) cm 24 hours after surgery, and the reduction was (23.4±11.2) cm, and the postoperative relief time of abdominal distension was (1~6 days) 1.9 days. There were 62 cases (80.5%) with complete cure, nine cases (11.7%) with improvement, six cases (7.8%) without improvement, and the clinical success rate was 93.5%. Three patients (3.9%) had abdominal pain, and one (1.3%) had a small amount of blood in the stool. Surgical treatment was performed on 26 patients 5~14 days after metal stent implantation, and wound infection occurred in one patient, without complications of intestinal fistula and intestinal obstruction. The stent patency rate was 92.2% at one month, 84.7% at three months, 68.4% at six months and 46.9% at twelve months.

Conclusion

Metal stent implantation is a safe and effective treatment for colorectal cancer obstruction. Meanwhile, the rigid guidance technique can improve the technical success rate.

表1 研究对象的临床特征
图1 金属支架置入术治疗降结肠严重狭窄病例。1A:腹部平片示腹腔内见肠腔积气,见宽大液气平面;1B:造影显示降结肠严重狭窄,仅有一缝隙通过造影剂;1C:导丝导管配合下成功通过狭窄段,放置支架成功;1D:术后3天复查腹部平片:支架膨胀良好,部分肠腔胀气及液气平面明显好转
图2 金属支架置入术治疗结肠迂曲合并狭窄病例。2A及2B:造影显示降结肠迂曲、冗长;2C:采用双鞘技术,经肛门再引入一8F导管及Amplatz导丝,可见迂曲肠道顺直,粗箭头:泥鳅加硬导丝,细箭头:Amplatz导丝;2D:导丝导管配合下支架成功通过迂曲段到达狭窄部位,金属支架放置成功
[1]
张楠,周振理,徐斌, 等. 5 923例急性肠梗阻的病因学变迁及中西医结合诊治[J]. 中国中西医结合外科杂志, 2013, 19(6): 618-619.
[2]
Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society [J]. CA: A Cancer Journal for Clinicians, 2018, 68(4): 250-281.
[3]
Siegel RL, Miller KD, Fedewa SA, et al. Colorectal cancer statistics, 2017 [J]. CA: A Cancer Journal for Clinicians, 2017, 67(3): 104-117.
[4]
Leitman IM, Sullivan JD, Brams D, et al. Multivariate analysis of morbidity and mortality from initial surgical management of obstructing carcinoma of the colon [J]. Surgery, Gynecology & Obstetrics, 1992, 174(6): 513-518.
[5]
Martinez-Santos C, Lobato RF, Fradejas JM, et al. Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates[J]. Diseases of the Colon & Rectum, 2002, 45(3): 401-406.
[6]
Amelung FJ, Burghgraef TA, Tanis PJ, et al. Critical appraisal of oncological safety of stent as bridge to surgery in left-sided obstructing colon cancer; a systematic review and meta-analysis [J]. Critical Reviews in Oncology/Hematology, 2018, 131: 66-75.
[7]
Verstockt B, Van Driessche A, De Man M, et al. Ten-year survival after endoscopic stent placement as a bridge to surgery in obstructing colon cancer[J]. Gastrointestinal Endoscopy, 2018, 87(3): 705-713.
[8]
Mashar M, Mashar R, Hajibandeh S. Uncovered versus covered stent in management of large bowel obstruction due to colorectal malignancy: a systematic review and meta-analysis [J]. International Journal of Colorectal Disease, 2019, 34(5): 773-785.
[9]
Lee YJ, Yoon JY, Park JJ, et al. Clinical outcomes and factors related to colonic perforations in patients receiving self-expandable metal stent insertion for malignant colorectal obstruction[J]. Gastrointest Endosc, 2018, 87(6): 1548-1557.
[10]
Ribeiro IB, Moura DTHD, Thompson CC, et al. Acute abdominal obstruction: Colon stent or emergency surgery? An evidence-based review [J]. World Journal of Gastrointestinal Endoscopy, 2019, 11(3): 193-208.
[11]
杨维忠,崔光锐,温必盛, 等. 超细内镜辅助金属支架置入治疗结直肠癌合并急性肠梗阻的临床研究[J]. 中华消化内镜杂志, 2019, 36(2): 133-135.
[12]
Park S, Cheon JH, Park JJ, et al. Comparison of efficacies between stents for malignant colorectal obstruction: a randomized, prospective study [J]. Gastrointestinal Endoscopy, 2010, 72(2): 304-310.
[13]
Moon CM, Kim TI, Lee MS, et al. Comparison of a newly designed double-layered combination covered stent and d-weave uncovered stent for decompression of obstructive colorectal cancer: A prospective multicenter study[J]. Diseases of the Colon & Rectum, 2010, 53(8): 1190-1196.
[14]
Han K, Song HY, Kim JH, et al. Afferent loop syndrome: treatment by means of the placement of dual stents [J]. AJR Am J Roentgenol, 2012, 199(6): W761-W766.
[1] 罗青杉, 梅海涛, 郝家领, 蔡锦锋, 周润楷, 温玉刚. 连接蛋白43通过调控细胞周期抑制结直肠癌的增殖机制研究[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 344-349.
[2] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[3] 陈文进, 张月君, 王传泰. 腹腔镜远端胃癌根治术后肠梗阻发生的影响因素研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 389-392.
[4] 谢丽春, 欧庆芬, 张秋萍, 叶升. 简化和标准肝脏MRI方案在结直肠癌肝转移患者随访中的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 434-437.
[5] 施烨鑫, 马翔, 鲁明, 夏青城, 王鹏超, 宋青雨, 赵庆洪. 腹腔镜下结直肠肿瘤定位研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 463-466.
[6] 严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
[7] 赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
[8] 黄海洋, 邝永龙, 陈嘉胜. 基层医院结直肠肿瘤经自然腔道取标本手术30 例分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 510-518.
[9] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[10] 关国欣, 罗福文. 结肠癌合并急性梗阻的个性化处理[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 459-463.
[11] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
[12] 张蔚林, 王哲学, 白峻阁, 黄忠诚, 肖志刚. 利用TCGA数据库构建基于miRNA的结直肠癌列线图预后模型[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 381-388.
[13] 张伟伟, 陈启, 翁和语, 黄亮. 随机森林模型预测T1 期结直肠癌淋巴结转移的初步研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 389-393.
[14] 任佳琪, 刁德昌, 何自衍, 张雪阳, 唐新, 李文娟, 李洪明, 卢新泉, 易小江. 网膜融合线导向的脾曲游离技术在左半结肠癌根治术中的应用[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 362-367.
[15] 张迪, 王春霞, 张学东, 李发馨, 庞淅文, 陈一锋, 张维胜, 王涛. 梗阻性左半结直肠癌自膨式金属支架置入后行腹腔镜手术与开腹手术的短期临床疗效比较[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 375-380.
阅读次数
全文


摘要