Endoscopy：全包覆自展开金属支架用于良性结肠狭窄治疗

　　最近发表在《Endoscopy（内镜）》杂志上的一篇文章肯定了全包覆自展开金属支架用于良性结肠狭窄治疗的有效性。[Endoscopy 2012: DOI: 10.1055/s-0032-1325769]

　　未包覆自展开金属支架可以有效缓解结肠梗阻。而法国的Vanbiervliet医生的研究小组肯定了全包覆自展开金属支架用于良性结肠狭窄治疗的有效性。

　　所有症状性良性结肠狭窄的病人都接受了为期六年的全包覆自展开金属支架治疗的研究。支架在放置4至6周后在内镜中心取出。

　　随访过程评估了支架的有效性、放置技术、支架移除、安全性和症状复发程度。使用单因素和多因素分析鉴别临床治疗成功率、支架移位和症状复发的因素。

　　研究小组评价了43例伴有梗阻或轻度梗阻病人，病因包括吻合性梗阻、缺血后梗阻或放疗后狭窄。研究发现所有病人的支架都置入成功，81%的病人临床治疗成功，63%的病人的支架出现移位。支架放置时间的中位数为21天，直径大于20毫米的支架移位的可能性较低。53%的病人出现了梗阻症状复发，与支架移位无关。研究没有发现复发和治疗有效性的预测性因素。

　　Vanbiervliet的研究小组总结道：“尽管自发移位的可能性较大，全包覆自展开金属支架对于良性结肠狭窄的治疗仍是安全有效的。”

Fully covered self-expanding metal stents for benign colonic strictures

Background and study aims

Uncovered self-expanding metal stents offer effective relief for colonic obstruction. The aim of this study was to determine the effectiveness of fully covered self-expanding metal stents (FCSEMSs) in the treatment of benign colonic strictures.

Patients and methods

All patients presenting with a symptomatic benign colonic stricture (occlusion or subocclusion) during a 6-year study period were treated with FCSEMSs. The stents were placed and removed 4 - 6 weeks later at one of 10 endoscopy centers. The efficacy of the stent (clinical and radiological signs of colonic decompression within 48 hours), technical success, stent retrieval, safety, and recurrence of symptoms were evaluated during follow-up. Univariate and multivariate analyses were performed to identify variables associated with clinical success, stent migration, and symptom recurrence.

Results

The study included 43 patients (24 men, 19 women; mean age 67.6 ± 10.4) with occlusive (n = 18) or subocclusive symptoms (n = 25) due to anastomotic (n = 40), post-ischemic (n = 2), or post-radiation (n = 1) strictures. Insertion was successful in all patients. Clinical success was obtained in 35 patients (81 %). Migration was observed in 27 patients (63 %). The median duration of stenting was 21 days (95 %CI 17.8 - 35.4 days). Multivariate analysis showed that stents more than 20 mm wide migrated significantly less often. Recurrence of obstructive symptoms was observed in 23 patients (53 %), irrespective of migration. No predictive factors for recurrence or clinical efficacy were found.

Conclusions

FCSEMSs for treatment of symptomatic benign colonic strictures are safe and effective, despite a high rate of spontaneous migration.