胃、十二指肠恶性梗阻的内支架治疗

INNER-STEM TREATMENT IN MALIGNANT GASTRO- DUODENAL STENOSIS

目的评价内支架成形在治疗胃、十二指肠恶性梗阻中的作用。方法1996年10月～1998年1月我们为18例胃、十二指肠狭窄或梗阻的病例实施了内支架安置术。其中胃体及幽门都阻塞4例，十二指肠降段和水平段阻塞9例，胃手术后吻合口狭窄5例。狭窄或梗阻的病因为恶性病变浸润或压迫。结果18例共安置支架21枚，其中国产镍钛合金金属支架20枚，进口不锈钢丝网状支架1枚。支架安置一次成功率80．1％。支架安置后所有病例临床症状均获缓解（17例）或明显好转（1例）。术后1月复查支架通畅率95％，无1例支架移位。结论内支架成形治疗能有效缓解胃、十二指肠梗阻，提高患者的生存质量、延缓晚期肿瘤的生存时间。

Assessment of palliation of patients with advanced malignancies complicated with gastroduodenalstenosis by the installation of duodenal stent to restore peroral food intake. METHODS 18 cases of malignant gastro-duodenal stenosis due to primary pancreatic carcinoma and/or pancreatic metastasis from malignancy of stomach or liver were admitted from Oct. 1996-Jan. 1998 in our unit. Age ranged from 20 to 69 years. All diagnoseswere proved by CT scans,upper GI series or endoscopies. All cases were explored. All had frequent vomiting afteranything peroral intake. After implantation of the stent at the proper position for 12 hrs, the patient was allowed totake food. RESULTS A total of 21 self-expanding metallic endoprosthesis were implanted in the 18 cases, amongwhich 20 had been made in China, and 1 had been made of imported stainless wire network. The primary successrate of implantation was 80. 1 %. All patients could eat normal diet after implantation with clinical symptomatic remission (17 cases) or much improved general condition(I case). 1 month postoperation examination showed stentunobstructed rate was 95%, no stent migration. CONCLUSION Implantation of self-expanding metallic endoprosthesis for the palliative treatment of malignant gastro-duodenal stenosis is rewarding and practical. It can prepare the patient for further comprehensive therapy of the original seemingly terminal stage disease with the hope ofprolonging life and decreasing suffering.