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综述

自膨式金属支架治疗梗阻性左半结肠癌的治疗现状

Status of self-expanding metal stent in obstructive left colon cancer treatment

:103-109
 
我国结直肠癌的发病率与死亡率逐年增加,约10%~30%新发结直肠癌患者可表现为急性肠梗阻,其中梗阻发生率较高的主要部位是左半结肠。急性梗阻性左半结肠癌患者的主要治疗方式仍是急诊手术(ES),但术后并发症发生率及围手术期死亡率较高,自膨式金属支架(SEMS)被一些指南推荐为梗阻性结肠癌的初始治疗选择,SEMS可将部分ES转变为择期手术,支架置入后择期手术(SBTS)与ES相比不仅可改善患者的短期生存结局,且支架置入后新辅助化疗为梗阻性结肠癌的治疗提供了新的途径;就长期生存结果而言,选择SBTS还是ES存在一定的争议。对于支架置入后手术时机的选择尚未达成共识,有指南表明大约两周的短桥接间隔可使患者最大程度获益,因而可有效指导临床工作。肠道支架置入术目前看来是一种简单、有效的临时性或永久性的治疗手段。
In recent years, the incidence and mortality of colorectal cancer in our country have been increasing year by year.Around 10% to 30% of newly diagnosed colorectal cancer patients showed acute intestinal obstruction, which the left colon cancer has higher incidence.Emergency surgery(ES)is still the main treatment for patients with acute obstructive left colon cancer, but the incidence of postoperative complications and perioperative mortality are high.Self-expanding metallic stents(SEMS)can convert some emergency procedures into stent as bridge to surgery(SBTS), which is recommended by some guidelines as the initial treatment option for obstructive colon cancer.SBTS can not only improve the short-term survival outcome of patients compared with ES, but also provide a new approach for the treatment of obstructive colon cancer with neoadjuvant chemotherapy after intestinal obstruction stent placement.The choice of SBTS versus ES is somewhat controversial in terms of long-term survival outcomes.There is no consensus on the timing of surgery after stenting, and current guidelines suggest that bridging intervals of approximately two weeks strike a balance between potential adverse events and long-term outcomes.At present, intestinal stenting is still a simple, feasible and effective temporary or palliative permanent treatment with few complications.
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