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題 名 | The Role of Colonic Stents in Obstructive Metastatic Colorectal Cancers=大腸支架在阻塞性轉移性大腸直腸癌的角色 |
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作 者 | 江驊哲; 丁文謙; 陳自諒; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
卷 期 | 20:1 2009.03[民98.03] |
頁 次 | 頁13-19 |
分類號 | 416.245 |
關鍵詞 | 大腸支架; 大腸阻塞; Colonic stent; Colon obstruction; |
語 文 | 英文(English) |
中文摘要 | 目的 : 自擴式金屬支架廣泛使用在各種阻塞性病灶。對於阻塞性大腸直腸癌提供另一種治療方式。在台灣,使用的病例數較少。本文中,大腸支架使用於阻塞性、轉移性及無法手術的大腸直腸癌的辜息性療法,我們回顧性探討使用經驗。 方法 : 從2004年三月到2007年三月,在中國醫藥大學附設醫院共有15位病人使用大腸支架。我們對於他們的病例作了回顧性探討。所有的病人在開始評估時皆為不適宜手術或者病人拒絕手術。我們分析了支架置放的技術性成功率及臨床成功率。此外,所有病人的年齡、病灶位置、併發症、死亡率以及併發症後的進一步的處理方式都做了詳細的統計及分析。 結果 : 共有八位男性及七位女性,平均年齡為66歲(從42到94歲不等)。病灶部位為上直腸(6位)、直腸乙狀結腸交接處(4位)、乙狀結腸(3位)、降結腸(1位)、大腸脾彎處(1位)。技術性成功率為80%及臨床成功率為60%。有2位病人產生與支架相關的腸穿孔而需要緊急手術。有四位病人產生併發症。對於第四期病人(10位)的平均存活時間為7個月(介於1到16月)。整體而言,沒有與支架相關的死亡病例。 結論 : 自擴式金屬支架對於惡性腫瘤所引起的大腸阻塞技術上是可行的,但是它卻有著較高的併發症。自擴式金屬支架對於惡性腫瘤所引起的大腸阻塞是一種可以選擇的處理方式但不應該被鼓勵。因此,自擴式金屬支架在使用時,應該要衡量臨床上的優劣得失與經濟效益。 |
英文摘要 | Purpose. Self-expandable metallic stents (SEMS) have been widely used in obstructive lesions. They are an alternative treatment for obstructive colorectal tumors. In this article, we retrospectively review our experience with placement of colonic stents for palliative treatment of obstructive metastatic colorectal cancers and inoperable colorectal cancers. Methods. From March 2004 to March 2007, we inserted SEMS in 15 patients. A retrospective chart review was undertaken at the China Medical University Hospital. For all patients, surgical treatment was not considered initially or the patients refused surgery. We analyzed the technical and clinical success rates of stent placement. All patients were characterized in terms of age, localization of tumor, complications, morbidity and mortality, and the necessity for further interventions. Results. Our subjects included eight males and seven females, with a mean age of 66 years (range 42-94 years). Sites of the lesion included six upper rectum, four rectosigmoid junction, three sigmoid colon , one descending colon , and one splenic flexure of colon. The stents were successfully implanted in 12 of the 15 patients and bowel obstruction relieved in all patients; the technical success rate was 80% and clinical success rate was 60%. Two patients with stent related perforations required emergency operation on the 4th or 18th day after stent implantation. The mean survival time (stent implantation to death) of the ten stage IV patients (n = 10) was 7 months (range 1-16months). Four patients had complications. In general, there was no stent-related mortality. Conclusions. Self-expandable metallic stents in patients with malignancy-induced colorectal obstruction is technically feasible, but it has higher morbidity rate in our study. Colonic stent is an alternative option in treatment of obstructed colorectal malignancy, but is not encouraged for every patient. When use of SEMS, surgeon or gastroenterologist should evaluate the clinical benefits and cost effectiveness for the patient. |
本系統中英文摘要資訊取自各篇刊載內容。