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中国现代手术学杂志  2018, Vol. 22 Issue (1): 1-5    DOI: 10.16260/j.cnki.1009-2188.2017.03.001
  手术学研究 |
非透视结肠自扩张金属支架置入过渡治疗急性梗阻性结直肠癌的临床分析
刘祺,卢太亮,董宏宇,房志学,黄兴,吴俊杰,黄忠诚
湖南省人民医院结直肠肛门外科,长沙 410005
The Clinical Analysis of Colon Self-expanding Metal Stents without Fluoroscopic Monitoring for theTransitional Treatment of Acute Obstruction in Colorectal Cancer Patients
LIU Qi,LU Tai-liang,DONG Hong-yu,FANG Zhi-xue,HUANG Xing,WU Jun-jie,HUANG Zhong-cheng
Department?of?Colorectal?and?Anus?Surgery,Hunan?Province?People's?Hospital,Changsha?410005,Hunan,China
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摘要 ?目的?探讨非透视下结肠自扩张金属支架置入治疗急性梗阻性结直肠癌患者的安全性和有效性。方法?回顾性分析2014年3月至2017年12月湖南省人民医院63例非透视结肠自扩张金属支架置入治疗急性梗阻性结直肠癌患者的临床资料。采用双人肠镜操作法,进镜至肿瘤部位后探寻狭窄孔并插入非血管腔道导丝,沿导丝将自扩张金属支架置入并通过狭窄段,释放支架于目的位置。结果?63例急性梗阻性结直肠癌患者中升结肠及结肠肝曲癌1例,横结肠癌2例,结肠脾曲癌6例,降结肠癌9例,乙状结肠癌29例,直乙交界及直肠癌16例。支架置入成功率100%,支架置入操作时间为5~35min,平均(12.3±4.6)min。除1例严重感染合并水电解质酸碱平衡紊乱患者术后1d死亡外,其余患者均术后第2d进食流质饮食,2~4d左右临床症状完全缓解,于术后2~3周手术治疗。结论?非透视下结肠自扩张金属支架置入治疗急性梗阻性结直肠癌患者安全有效,是急性梗阻性结直肠癌由急诊手术向限期手术转变的有效过渡治疗手段。
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刘祺,卢太亮,董宏宇,房志学,黄兴,吴俊杰,黄忠诚
关键词:  结直肠肿瘤  结肠梗阻  结肠支架  非透视  结肠镜检查    
Abstract: ?Objective?To evaluate the efficacy and safety of colonoscopy guided placement of self-expanding metallic stents (SEMS) without fluoroscopic monitoring in the emergence management for acute malignant colorectal obstruction.Methods?Clinicaldata of 63 patients undergoing colonoscopy guided placement of self-expanding metallic stents without fluoroscopic monitoring for acute malignant colorectal obstruction between March,2014 and December,2017 were reviewed retrospectively.Results?The obstruction was located in the ascending colon andhepatic flexure(n=1),transverse colonic carcinoma(n=2),splenic flexure(n=6),descending colon(n=9),sigmoid(n=29),rectosigmoid junction and rectum(n=16) .Technical success was achieved in all the 63 patients (100%).Mean time of operation was (12.3±4.6)min(range,5~35min).One patientdied on the firstday after operation because of severe infection with electrolyte acid-base balancedisorder.The rest patients received liquiddiet on the secondday after operation,and the clinical symptoms were completely relieved within 2~4days.Colorectal cancer radical surgery was performed 2~3 weeks after the colon self-expanding metal stenting.Conclusions?Colonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring in emergence management for acute malignant colorectal obstruction is effective and safe.It is a useful transitional treatment for acute obstructive colorectal cancer from emergency operation to limited operation.
Key words:  colorectal neoplsmslarge bowel obstruction    colonic stenting    non-fluoroscopy    colonoscopy
                    发布日期:  2018-08-13      期的出版日期:  2018-08-13
ZTFLH:  R735.3  
通讯作者:  刘祺,男,41岁,湖南省人民医院结直肠外科副主任医师,医学博士,硕士生导师。   
作者简介:  刘祺,男,41岁,湖南省人民医院结直肠外科副主任医师,医学博士,硕士生导师。
引用本文:    
刘祺,卢太亮,董宏宇,房志学,黄兴,吴俊杰,黄忠诚. 非透视结肠自扩张金属支架置入过渡治疗急性梗阻性结直肠癌的临床分析[J]. 中国现代手术学杂志, 2018, 22(1): 1-5.
LIU Qi. The Clinical Analysis of Colon Self-expanding Metal Stents without Fluoroscopic Monitoring for theTransitional Treatment of Acute Obstruction in Colorectal Cancer Patients. Chinese Journal of Modern Operative Surgery, 2018, 22(1): 1-5.
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