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良性结肠狭窄支撑架治疗的结果

时间:2010-05-19 18:30来源:未知 作者:Mr.Editor
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 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),其中吻合口

        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。

 

1. Ilona Keränen , Anna Lepistö‌, Marianne Udd‌, Jorma Halttunen‌ & Leena Kylänpää,  ‌Outcome of patients after endoluminal stent placement for benign colorectal obstruction, Scandinavian Journal of Gastroenterology, June 2010, Vol. 45, No. 6, Pages 725-731

2. Garcea G, Sutton CD, Lloyd TD, Jameson J, Scott A, Kelly MJ. Management of benign rectal strictures: a review of present therapeutic procedures. Dis Colon Rectum 2003;46:1451–60. 

3. King DW, Lubowski DZ, Armstrong AS. Sigmoid stricture at colonoscopy – an indication for surgery. Int J Colorectal Dis 1990;5:161–3. 

4. Schlegel RD, Dehni N, Parc R, Caplin S, Tiret E. Results of reoperations in colorectal anastomotic strictures. Dis Colon Rectum 2001;44:1464–8. 

5. Meisner S, Hensler M, Knop FK, West F, Wille-Jorgensen P. Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center. Dis Colon Rectum 2004;47:444–50. 
6. Suzuki N, Saunders BP, Thomas-Gibson S, Akle C, Marshall M, Halligan S. Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Dis Colon Rectum 2004;47:1201–7. 
7. Forshaw MJ, Sankararajah D, Stewart M, Parker MC. Self-expanding metallic stents in the treatment of benign colorectal disease: indications and outcomes. Colorectal Dis 2006;8:102–11. 
8. Salinas JC, Quintana J, De Gregorio MA, Insignares E, Gil I, Lozano R. Management of benign rectal stricture by implantation of a self-expanding prosthesis. Br J Surg 1997;84:674. 
9. Davidson R, Sweeney WB. Endoluminal stenting for benign colonic obstruction. Surg Endosc 1998;12:353–4.  
10. Yates MR 3rd, Baron TH. Treatment of a radiation-induced sigmoid stricture with an expandable metal stent. Gastrointest Endosc 1999;50:422–6. 
11. Piccinni G, Nacchiero M. Management of narrower anastomotic colonic strictures. case report and proposal technique. Surg Endosc 2001;15:1227. 
12. Law WL, Choi HK, Chu KW, Tung HM. Radiation stricture of rectosigmoid treated with self-expanding metallic stent. Surg Endosc 2002;16:1106–7. 
13. Seo TS, Song HY, Sung KB, Ko GY, Yu CS. A benign colorectal stricture: treatment with a retrievable expandable nitinol stent. Cardiovasc Intervent Radiol 2003;26:181–3. 
14. Baron TH, Dean PA, Yates MR 3rd, Canon C, Koehler RE. Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc 1998;47:277–86. 
15. Tamim WZ, Ghellai A, Counihan TC, Swanson RS, Colby JM, Sweeney WB. Experience with endoluminal colonic wall stents for the management of large bowel obstruction for benign and malignant disease. Arch Surg 2000;135:434–8. 
16. Stefanidis D, Brown K, Nazario H, Trevino HH, Ferral H, Brady CE 3rd, et al. Safety and efficacy of metallic stents in the management of colorectal obstruction. J Soc Laparoendosc Surg 2005;9:454–9. 
17. Dafnis G. Repeated coaxial colonic stenting in the palliative management of benign colonic obstruction. Eur J Gastroenterol Hepatol 2007;19:83–6. 
18. Athreya S, Moss J, Urquhart G, Edwards R, Downie A, Poon FW. Colorectal stenting for colonic obstruction: the indications, complications, effectiveness and outcome – 5 year review. Eur J Radiol 2006;60:91–4. 
19. Jost RS, Jost R, Schoch E, Brunner B, Decurtins M, Zollikofer CL. Colorectal stenting: an effective therapy for preoperative and palliative treatment. Cardiovasc Intervent Radiol 2007;30:433–40. 
20. Pommergaard HC, Vilmann P, Jakobsen HL, Achiam MP. A clinical evaluation of endoscopically placed self-expanding metallic stents in patients with acute large bowel obstruction. Scand J Surg 2009;98:143–7.  
21. Paul L, Pinto I, Gomez H, Fernandez-Lobato R, Moyano E. Metallic stents in the treatment of benign diseases of the colon: preliminary experience in 10 cases. Radiology 2002;223:715–22. 
22. Watson AJ, Shanmugam V, Mackay I, Chaturvedi S, Loudon MA, Duddalwar V, et al. Outcomes after placement of colorectal stents. Colorectal Dis 2005;7:70–3. 

23. Rayhanabad J, Abbas MA. Long-term outcome of endoscopic colorectal stenting for malignant and benign disease. Am Surg 2009;75:897–900.  
24. Bertelsen CA, Meisner S, West F, Wille-Jorgensen PA. Treatment of colorectal obstruction with self-expanding metal stents. Ugeskr Laeger 2006;168:907–11.  

23. Small AJ, Young-Fadok TM, Baron TH. Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases. Surg Endosc 2008;22:454–62. 
 

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