장폐색을 동반한 좌측 대장암에서 자가팽창형 금속 스텐트 삽입의 임상적 효과: 응급 수술과의 비교 = Clinical Outcomes of Self-Expanding Metal Stent Insertion for Obstructive Left-Sided Colorectal Cancer: Comparison with Emergency Operation

다국어 초록 (Multilingual Abstract)

Background/Aims: The aim of this study was to compare the outcome of colorectal stenting with that of performing emergency operation for the patients with malignant left-sided colon obstruction. Methods: The patients with obstructing left-sided colorectal cancer were treated with 'bridge to surgery stenting' and this was followed by operation (group A, n=20), emergency operation (group B, n=21), palliative stenting (group C, n=16), and emergency palliative operation (group D, n=15). Results: The primary anastomosis rate was significantly higher for group A than for group B (65.0 vs. 33.3%, respectively, p＜0.05). None of the patients in group A required intensive care and 3 patients in group B required intensive care. Post-operative complications occurred in 2 and 3 patients in group A and B, respectively. The mean hospital stay showed the tendency to be shorter for group A than for group B (24 vs. 31 days, respectively, p＞0.05). In regard to palliative treatment, the stoma creation rate was 86.7% for group D, and 2 patients in group D needed intensive care. The mean hospital stay was significantly shorter for group C than for group D (9.3 vs. 20.7 days, respectively, p＜0.05). Conclusions: Stent placement is a useful alternative to emergency surgery for the management of malignant colorectal obstruction. (Korean J Gastrointest Endosc 2006;32:253-259)

국문 초록 (Abstract)

목적: 좌측 대장암으로 인한 장폐색에서 스텐트 삽입의 임상적 효용성을 알아보고 이를 응급 수술과 비교하고자 하였다. 대상 및 방법: 1999년 1월부터 2003년 12월까지 장폐색을 동반한 좌측 대장암으로 치료받은 총 72명의 환자를 대상으로 하였다. 스텐트는 내시경적 방법으로 방사선 조영하에 삽입하였고 대상 환자는 근치적 절제가 가능한 환자와 진행된 병기 또는 환자의 불량한 전신상태로 인해 고식적 치료만 가능한 환자로 구분하여 스텐트를 삽입한 후 근치적 절제를 시행한 A군(20예)과 스텐트 삽입없이 응급 수술을 시행한 B군(21예)의 임상 결과를, 고식적 목적으로 스텐트를 삽입한 C군(16예)과 고식적 수술을 시행한 D군(15예)의 임상 결과를 비교하였다. 결과: A군에서 1회로 근치적 수술이 가능했던 환자수는 13명(65.0%)으로 B군의 7명(33.3%)에 비해 유의하게 많았다(p＜0.05). 첫 수술 후 B군에서는 3명의 환자가 중환자실 치료를 요하였으나 A군에서는 없었으며, 수술 후 합병증으로 A군에서는 창상 감염과 균혈증이 각각 1명씩 발생하였고(10.0%) B군에서는 창상 감염이 2명, 문합부위 누출이 1명에서 있었다(14.3%). 평균 재원기간에서, A군이 24일로 B군의 31일에 비해 짧은 경향을 보였다. C군에서 스텐트 삽입 후 장폐색이 지속되어 수술로 전환한 경우가 2예(12.5%) 있었고, D군에서는 13명(86.7%)에서 장루조성이 필요하였다. C, D군에서 병원 내 사망 환자는 없었으나, D군에서 수술 후 2명의 환자가 중환자실 치료를 받았다. 평균 재원일수는 각각 9.3일, 20.7일로 D군에 비하여 C군에서 유의하게 짧았고(p＜0.05), 양 군 간의 생존율 차이는 없었다. 결론: 장폐색을 동반한 좌측 대장암에서 스텐트 삽입은 응급 수술에 비하여 총수술 횟수 및 수술 후 합병증의 감소, 재원기간 단축 등에서 효과적이고 안전한 시술이다.

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