大腸直腸阻塞病人接受自動擴張性金屬支架置入－病歷報告及文獻回顧

一位子宮頸癌病患，接受根除性子宮切除術及骨盆腔淋巴腺廓清術後，發現癌腫塊於骨盆腔復發，並發現有肝臟及肺臟多發性轉移。因長期便秘症狀達一個月住院。經下腸胃道攝影，診斷乙狀結腸因腫瘤浸潤壓迫而極度狹窄。經討論，病人同意接受自動擴張性金屬支架置入(Self-Expandable Metallic Stent)，如效果不佳，再接受大腸造廔手術。經放射線部醫師以放射線透視攝影導引(Fluoroscopy-guided)成功置入，但仍無法有效擴張腸道，病人於置入後十一天接受大腸造廔手術(Colostomy)。大腸直腸的阻塞通常需要藉助大腸造廖術以求緩解。本文回顧十篇研究，探討這樣的阻塞以“自動擴張性金屬支架置入術”而緩解阻塞，其長期的影響如何。共有二百零七為病人包括在這些研究中。其阻塞原因，包括原發性大腸癌、復發性大腸癌、轉移性癌腫塊、及大腸炎性疾病。在放射線透視攝影及內視鏡導引下，93.2%的病人得以成功置入此種支架，而88.9%的病人其腸道重新恢復暢通。若依置入復的治療意向，將病人分為“手術前率備”或“緩和醫療”兩組，接受緩和醫療的這組病人有77.8%終其一生保持腸道暢通而不需接受大腸造廔手術。與置入支架相關之併發症為25.1%，相關之死亡率為3.4%。

關鍵字

大腸直腸阻塞；自動擴張性金屬支架；骨盆腔腫瘤

並列摘要

A 37 year-old female, a victim of cervical cancer after radical hysterectomy, had pelvic recurrence and multiple metastasis in lung and liver. She was admitted for chronic constipation for one month. Barium enema revealed colon obstruction from tumor infiltration in sigmoid colon. After discussion, the patient consented for a procedure using self-expandable metallic stent to relieve the obstruction site before a surgical diversion. The metallic stent was inserted successfully but failed to achieve functional relief of the obstruction. Colostomy was performed 11 days after the insertion of the stent. Traditionally, colorectal obstruction usually leads to a diversion colostomy for decompression. A review on 10 studies was carried out to show the long-term effect of the procedure using self-expandable metallic stents (SEMS) to relieve colorectal obstruction. As many as 207 patients were included in the review. The causes of the colorectal obstruction were primary colorectal cancer, recurrent colorectal cancer, metastatic malignancies, and chronic inflammatory colon disease. Using the procedure under fluoroscopy and/or endoscopy guidance, the stent was successfully placed in 93.2% of the patients and resulted in functional relief in 88.9% of the patients. When divided the patients into 2 groups according to the initial intention of treatment after the relief of obstruction (pre-operative or palliative group), 77.8% of the patients in the palliative treatment group enjoyed normal bowel function for the rest of their lives without acquiring a colostomy. The initial morbidity rate was 25.1% and the procedure-related mortality rate was 3.4% for the palliative treatment group.

並列關鍵字

Colorectal Obstruction ； Self-expandable metallic stent ； Pelvic Mass

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大腸直腸阻塞病人接受自動擴張性金屬支架置入－病歷報告及文獻回顧

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