Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis
Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis
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DOI：
10.1007/s00464-003-8109-x
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发表时间：
2004-03-01
影响因子：
3.1
通讯作者：
Paraskevas, E
中科院分区：
文献类型：
--
作者：
Xinopoulos, D;Dimitroulopoulos, D;Paraskevas, E
背景：本研究的目的是比较不能手术的恶性结肠梗阻的治疗效果、安全性和成本。方法：30例因转移性、血流动力学不稳定或肺不稳定而不能手术的结直肠癌或卵巢癌合并左半结肠恶性梗阻的患者。15人随机接受姑息性金属结肠支架置入术，15人接受造口治疗。比较两种方法的疗效和安全性。结果：15例患者中有14例支架置入成功。在一名直肠乙状结肠弯曲梗阻的患者中，支架置入术是不可能的；该患者被排除在研究之外。在随访期内，6名患者观察到中度、非闭塞的肿瘤植入支架腔内；他们都接受了内部激光消融治疗。成本-效果分析显示，虽然造口手术费用较低，但两种方法的平均成本相差6.9%(132欧元)。结论：对于不能手术的恶性结肠狭窄患者，自膨式金属支架置入是一种姑息性的结肠造口术替代方法。这种治疗方案为患者提供了更好的生活质量，没有结肠造口的心理影响，而且似乎具有成本效益。
Background: The aim of the present study was to compare the efficacy, safety, and cost of endoscopic palliative treatment with selfexpanding metallic stents with that of stoma creation in the management of inoperable malignant colonic obstructions.Methods: A total of 30 patients with inoperable malignant partial obstruction (due to metastases, hemodynamic instability, or pulmonary instability) in the left colon unsing from colorectal or ovarian cancer were included in the study. Fifteen were randomized to undergo palliative metallic colonic stent placement and 15 to undergo stoma creation. The efficacy and safety of the two methods was compared. A cost-effectiveness analysis was also performed, including the cost of postinterventional care.Results: Stents were placed successfully in 14 of 15 patients. In one patient with obstruction of a tortuous rectosigmoid flexure colon, stenting was not possible; this patient was excluded from the study. During the follow-up period, a moderate, nonocclusive ingrowth of tumor into the stent lumen was observed in six patients; they were all treated with internal laser ablation. The cost-effectiveness analysis showed that although the stoma creation procedure was less expensive, the total difference in average costs for the two methods was 6.9% (132 Euros).Conclusions: Self-expanding metallic stent placement is a palliative alternative to colostomy for patients with inoperable malignant colonic strictures. This treatment option provides a better quality of life for the patient, without the psychological repercussions of a colostomy, and it appears to be cost-effective.