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目的评估自膨式金属支架(self-expendable metallic stent,SEMS)置入治疗由肠外肿瘤(extracolonic ma-lignancies,ECM)所致的急性结直肠梗阻(acute colorectal obstruction,ACO)的安全性、有效性及其预后。方法复旦大学附属中山医院将2006年11月至2012年4月收治的109例恶性ACO病人纳入研究,其中已出现转移或术后复发的结直肠癌(colorectal cancer,CRC)病人96例,ECM病人13例,比较两组的成功率、并发症发生率与存活时间。结果 ECM组中胃癌8例(61.5%)、妇科肿瘤3例(23.1%)、膀胱癌1例(7.7%)、盆腔炎性纤维母细胞瘤1例(7.7%)。两组SEMS置入成功率均为100%,在临床缓解率方面差异无统计学意义(77.0%vs.83.3%,P=0.696)。在支架通畅时间方面差异无统计学意义(117±148.8vs.188.2±203.6,P=0.230)。ECM组的SEMS相关并发症为再梗阻2例和支架移位1例。1例SEMS置入后症状未缓解。两组间在30d病死率、1年存活率和总体存活率方面差异均无统计学意义(P=1.000,P=0.140,P=0.282)。结论 SEMS置入治疗由ECM所致ACO的安全性、有效性及预后与其条件相似的CRC所致ACO相近。SEMS置入是治疗恶性ACO的一个合适选择。
Objective To evaluate the safety of self-expendable metallic stent (SEMS) in the treatment of acute colorectal obstruction (ACO) caused by extracolonic ma-lignancies (ECM) Sex and its prognosis. Methods Zhongshan Hospital Affiliated to Fudan University enrolled 109 patients with malignant ACO from November 2006 to April 2012. There were 96 patients with colorectal cancer (CRC) who had metastasis or postoperative recurrence, 96 patients with ECM 13 cases, the success rate of two groups were compared, the incidence of complications and survival time. Results There were 8 cases of gastric cancer in ECM group (61.5%), 3 cases of gynecologic tumor (23.1%), 1 case of bladder cancer (7.7%) and 1 case of pelvic inflammatory fibroblastoma (7.7%). The success rate of SEMS in both groups was 100%, and there was no significant difference in clinical remission rate (77.0% vs 83.3%, P = 0.696). There was no significant difference in stent patency (117 ± 148.8 vs 188.2 ± 203.6, P = 0.230). There were 2 cases of re-obstruction and 1 case of stent dislocation in the ECS group. One case of SEMS after implantation did not alleviate the symptoms. There was no significant difference in the 30-day mortality, 1-year survival rate and overall survival between the two groups (P = 1.000, P = 0.140, P = 0.282). Conclusions The safety of SEMS in the treatment of ACO induced by ECM is similar to that of CRC with similar conditions and prognosis. SEMS implantation is a suitable treatment for malignant ACO.