三种方法治疗恶性胃出口梗阻患者生活质量的比较

A prospective comparative study of three treatment options in patients with malignant gastric outlet obstruction

目的 探讨恶性胃出口梗阻（GOO）患者的治疗选择.方法 对39例继发于不可切除的原发性或转移性消化系统肿瘤的GOO患者分别予以内镜下支架置入术（支架组,13例）、胃旁路手术（旁路组,21例）和经皮胃造口术（造口组,5例）,分别于术前、术后1、3个月采用QLQ-STO22表进行生活质量（QOL）评估.结果 本组39例患者术后中位生存时间是68 d,其中支架组（85 d）和旁路组（72 d）的中位生存时间明显长于造口组的48 d（P〈0.05）;但支架组与旁路组比较生存时间的差异无统计学意义（P〉0.05）.本组共有14例患者（支架组和旁路组各7例）在治疗前、治疗后1个月和3个月均完成了QOL调查,支架组患者吞咽困难、饮食限制、舌干及反流症状均得到明显改善（P〈0.05）;旁路组患者吞咽困难和饮食限制得到明显改善（P〈0.05）,但舌干、反流及疼痛症状则无明显改善（P〉0.05）.结论 尽管恶性GOO患者预后很差,旁路手术和内镜下支架置入术仍然能有效缓解恶性GOO患者的症状,可作为积极的治疗选择.

Objective To evaluate outcomes after different treatment options including endoscopic stent placement,surgical bypass,and percutaneous gastrostomy for malignant gastric outlet obstruction（GOO）.Methods Thirty-nine patients with GOO secondary to unresectable primary ormetastatic cancer were treated with endoscopic stent placement（group 1,n=13）,surgical bypass（group 2,n=21）,or percutaneous gastrostomy（group 3,n=5）.QLQ-STO22 form was used to assess quality of life（QOL）at baseline,1 month,and 3 months following intervention.Results Overall median survival time was 68 days.Median survival time in group 1 and group 2 was 85 and 72 days respectively,longer than that in group 3（48 days,P〈0.05）.Fourteen patients（7 cases in group 1 and 7 cases in group 2） completed all three QOL surveys.All the patients in group 1 had significant improvement in dysphagia,dietary restrictions,dry mouth,and reflux（P〈0.05）.In group 2,dysphagia and dietary restrictions were significantly improved（P〈0.05）,while there were no significant improvements in dry mouth,reflux and pain（all P〉0.05）.Conclusion Although the prognosis of malignant GOO is poor,endoscopic stent placement and surgical bypass may improve QOL of pafients and therefore are reasonable alternatives for palliation.