胃流出道恶性梗阻的金属支架置入治疗

Metal stent placement for treatment of malignant gastric outlet obstruction

目的探讨金属支架治疗胃流出道恶性梗阻的操作技术及其临床疗效。方法12例胃流出道恶性梗阻患者中,胃恶性淋巴瘤1例,胰体癌术后浸润胃肠吻合口1例,胃窦癌6例,胰头癌4例。在X线电视监视下经口置入国产镍钛合金网状裸支架。除4例体质虚弱外,余8例均接受动脉插管化疗或全身化疗。结果12例患者共放置金属支架14枚,其中,2例放置2枚支架。10例放置1次成功,2例放置2次成功。所有病例梗阻症状均明显缓解,并逐渐能进半固体软食,生活质量明显提高。随访2～18个月,2例出现支架梗阻后再次置入支架,1例胆道梗阻行胆道外引流术。未发生出血、穿孔、支架移位等严重并发症。结论金属支架是胃流出道恶性梗阻安全有效的治疗方法,可迅速缓解症状,改善患者体质,提高患者的生活质量,结合化疗有望延长患者的生存期。

Objective To study the technique of metal stent placement for the treatment of malignang gastric outlet obstruction, and evaluate its clinical effectiveness. Methods Under fluoroscopic guidance, 12 patients with malignant gastric outlet obstuction caused by gastric malignant lymphoma（ n = 1 ）, postoperative anastomotic stenosis（ n = 1 ）, gastric carcinoma at the antrum （ n = 6）, pancreatic head cancer（ n = 4）, were treated with placement of metal stent transorally. After stent placenent, 8 patients received inter- arterial or general chemotherapy. Results Fourteen stents altogether were successfully performed in 12 patients, and 1 time in 10 patients, 2 times in 2 patients All patients could eat semisolid food after stent placement with clinical symptomatic remission and living quality improvement. Follow- up for 2-18 months, reintervention（2 stents, 1 biliary drainage）was required in two of 12 patients for stent re -obstruction and obstructive jaundice. No stent - related gastrointestinal perforation, hemorrhage or migration was observed. Conclusions Metal stent is a safe and efficaeious method fur malignant gastric outlet obstruction, h can provide good palliation of clinical symptoms and improvement of living quality, and the hope of prolonging survival time in conjunction with chemotherapy.