技术成功率:技术成功是指将支撑架成功地输送到病变位置,支撑架释放后完全覆盖病变范围。对于有经验的操作者,支撑架的植人在技术上是可能的,不管狭窄时什么原因引起的。但是尽管技术上成功并不代表临床成功,并发症有时也高达50%[1]。
良性结肠狭窄的主要原因包括外科吻合口狭窄(包括Crohn's病吻合口狭窄,肿瘤切除术后吻合口狭窄),憩室性疾病狭窄和放疗后狭窄等。最常应用的治疗主要是球囊扩张[2],或如果需要进行外科手术[3,4]。使用结肠支撑架治疗良性结肠狭窄是有争议的,其有效性和安全性的结果也报道不一。只有有限的长期随访资料,而随机对照研究根本就不存在。多数文献仅仅为病例报告或小样本的研究[5~24]。截止站长编辑这一栏目为止,最大一组良性结肠狭窄支撑架治疗的报告是23例[25]。
Ilona等人[1]报告21例包括上述原因的良性结肠狭窄,使用23个支撑架。技术成功率为100%。临床成功率为76%(16/21),比之前的报告[5,7,8]有所提高,其中吻合口狭窄63%(5/8),憩室性疾病30%。9例(43%)发生并发症,多数为憩室性狭窄。似乎对于吻合口狭窄的病人结肠支撑架是一个较好的治疗选择,而对于不适合外科手术的良性结肠狭窄也是同样。憩室性狭窄的结肠支撑架治疗,作为外科手术的过渡,则要考虑并发症的风险,而且计划中的外科肠切除手术应当在一个月内进行。
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