Acute colonic obstruction: Clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents - A preliminary report
Acute colonic obstruction: Clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents - A preliminary report
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DOI：
10.1148/radiology.206.1.9423673
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发表时间：
1998-01-01
期刊：
影响因子：
19.7
通讯作者：
Zollikofer, CL
中科院分区：
文献类型：
--
作者：
Binkert, CA;Ledermann, H;Zollikofer, CL
目的：评估使用自膨胀金属支架作为术前或姑息治疗急性结肠梗阻的临床方面和成本效益。材料与方法：连续13例患者，年龄49-83岁（平均67岁），均有结肠梗阻的临床和放射学症状，其中10例作为术前手术，3例作为姑息治疗。在透视和内镜联合引导下，共植入16个自扩张金属支架（直径16 mm，完全扩张长度56 mm）。将这些费用（住院、重症监护病房、支架放置和手术）与同一家医院13名接受手术治疗的患者的费用进行比较。结果：13例患者中12例支架置入成功；所有患者均从机械性梗阻中恢复，术前治疗的9例患者中有8例可以进行单期手术。一个非常狭窄的狭窄无法通过。2例长狭窄患者在置入支架后5天出现功能障碍，分别在2周和6周出现再闭塞。由于住院时间缩短和并发症发生率降低，成本降低了19.7%。在术前治疗组结肠癌患者中，成本降低率提高到28.8%。结论：金属支架置入术在急性结肠梗阻患者中是一种微创且具有成本效益的术前手术，在大多数情况下可以进行单期手术。支架置入缓解应限于有特殊适应症的患者。
PURPOSE: Evaluation of clinical aspects and cost-effectiveness of use of self-expanding metallic stents in the treatment of acute colonic obstruction as either a preoperative procedure or palliation.MATERIALS AND METHODS: Thirteen consecutive patients, aged 49-83 years (mean, 67 years), with clinical and radiologic signs of colonic obstruction were treated, as a preoperative procedure in 10 patients and as a palliative treatment in three. A total of 16 self-expanding metallic stents (diameter, 16 mm; length fully expanded, 56 mm) were implanted with combined fluoroscopic and endoscopic guidance. The costs (hospitalization, intensive care unit, stent placement, and surgery) were compared with costs for 13 surgically treated patients at the same hospital.RESULTS: Stent placement was successful in 12 of the 13 patients; all recovered from mechanical obstruction, and single-stage surgery was possible in eight of nine patients treated preoperatively. One very narrow stenosis could not be passed. Dysfunction occurred in two long stenoses after 5 days with reocclusion 2 and 6 weeks, respectively, after stent placement. A cost reduction of 19.7% was observed as a result of shorter hospitalization and a lower complication rate. In patients with colon cancer in the preoperative treatment group, the cost reduction increased to 28.8%.CONCLUSION: Metallic stent placement in patients with acute colonic obstruction was minimally invasive and cost-effective preoperative procedure that allowed single-stage surgery in most cases. Stent placement for palliation should be limited to patients with special indications.