内容紹介
Summary
Background: The use of self-expandable metallic stent(SEMS)was first authorized by insurance and became available nationwide in Japan in 2012. Insertion of SEMS for colorectal obstruction due to colorectal cancer is useful as a bridge to surgery(BTS)approach and releases stenosis as palliative care. Aim: To assess the outcomes of SEMS placement for colorectal obstruction. Patients and methods: A total of 14 patients were treated with SEMS between April 2014 and March 2017. We reviewed their medical records to assess the usefulness of SEMS placement and the clinical course. Results: SEMS insertion was effective in 93% of the 14 patients. In 10 patients with BTS, the median interval between SEMS insertion and operation was 16 days, and no severe complications were noted in them. In 4 patients with palliative care, all patients were released from colorectal stenosis. Conclusion: SEMS placement played a satisfactory role in improvement of patient QOL by paying scrupulous attention to a colonic stent retained.
要旨
2012年より自己拡張型金属ステント(self-expandable metallic stent: SEMS)が保険収載され,大腸悪性狭窄に対する治療戦略は変遷しつつある。2014年4月～2017年3月までにわれわれが経験した,手術までの待機期間(bridge to surgery: BTS)としてのSEMS留置10例,他臓器癌転移による大腸狭窄に対する緩和目的としてのSEMS留置4例を対象に,その問題点について検討した。留置成功率は100%であったが,留置後のステント逸脱を1例(7%)認めた。BTSとしてのSEMS留置例の留置から手術までの待機期間は7～34(中央値16)日であり,Clavien-Dindo分類gradeⅢa以上の術後合併症は認めなかった。緩和目的のSEMS留置例では全例で姑息的手術を回避できた。SEMS留置は多くの利点が報告されており,偶発症の予防に留意すれば短期的には患者の大幅なQOL改善が図られる。長期的予後に関しては今後症例の蓄積,検討が必要と考えられる。
目次
Background: The use of self-expandable metallic stent(SEMS)was first authorized by insurance and became available nationwide in Japan in 2012. Insertion of SEMS for colorectal obstruction due to colorectal cancer is useful as a bridge to surgery(BTS)approach and releases stenosis as palliative care. Aim: To assess the outcomes of SEMS placement for colorectal obstruction. Patients and methods: A total of 14 patients were treated with SEMS between April 2014 and March 2017. We reviewed their medical records to assess the usefulness of SEMS placement and the clinical course. Results: SEMS insertion was effective in 93% of the 14 patients. In 10 patients with BTS, the median interval between SEMS insertion and operation was 16 days, and no severe complications were noted in them. In 4 patients with palliative care, all patients were released from colorectal stenosis. Conclusion: SEMS placement played a satisfactory role in improvement of patient QOL by paying scrupulous attention to a colonic stent retained.
要旨
2012年より自己拡張型金属ステント(self-expandable metallic stent: SEMS)が保険収載され,大腸悪性狭窄に対する治療戦略は変遷しつつある。2014年4月～2017年3月までにわれわれが経験した,手術までの待機期間(bridge to surgery: BTS)としてのSEMS留置10例,他臓器癌転移による大腸狭窄に対する緩和目的としてのSEMS留置4例を対象に,その問題点について検討した。留置成功率は100%であったが,留置後のステント逸脱を1例(7%)認めた。BTSとしてのSEMS留置例の留置から手術までの待機期間は7～34(中央値16)日であり,Clavien-Dindo分類gradeⅢa以上の術後合併症は認めなかった。緩和目的のSEMS留置例では全例で姑息的手術を回避できた。SEMS留置は多くの利点が報告されており,偶発症の予防に留意すれば短期的には患者の大幅なQOL改善が図られる。長期的予後に関しては今後症例の蓄積,検討が必要と考えられる。