经内镜放置幽门金属支架对胃出口梗阻的治疗价值

Therapeutic value of endoscopic metal pyloric stent implantation for gastric outlet obstruction

目的探讨经内镜放置幽门金属支架对胃出口梗阻的治疗价值。方法对2008年1月至2012年1月因多种良恶性疾病引起胃出口梗阻而接受内镜下幽门金属支架植入术的21例患者的病例资料进行回顾性分析。结果 21例成功进行了幽门十二指肠支架置入术,14例24小时内症状明显缓解,1例于48小时后行CRE球囊扩张后缓解,总缓解率为71.4%。21例中有3例十二指肠壶腹部受累伴梗阻性黄疸的病例成功进行了双支架的置入治疗。3例出现术中出血,对症治疗后停止。1例良性狭窄病例使用覆膜支架发生移位,4例出现支架术后再堵塞,其中2例行二次支架置入。恶性肿瘤引起的狭窄术后生存时间平均为2.5个月。结论对由于各种原因导致胃出口梗阻且无法手术或拒绝外科治疗的患者,幽门支架的置入可有效解除梗阻,改善患者生活质量。

Objective To evaluate the therapeutic value of endoscopic implantation of metal stent in gastric outlet obstruction. Methods Data of 21 patients who developed benign or malignant gastric outlet obstruction from January ：2008 to January 2011 were retrospectively reviewed. Results Endoscopic metal pyloric stents were successfully placed in 21 patients. Symptoms were subsided in 14 patients. 1 patient subsided after CRE ballon in 48 hours. Response rate was 71.4%. 3 duodenal patients ampulla involvement with cases of obstructive jaundice successfully treated two-stent implantation. Bleeding occurred in 3 patients, 1 case of benign stenosis using stent occurred dis- placement, Obstruction occurred in 4 patients, and 2 of them received the second metal pyloric stent. The average survival time of obstruction patient with malignant was 2.5 months. Conclusion No chance of surgical treatment or refuse surgery patients because of some causes gastric outlet obstruction can effectively remove the obstruction and improve patients quality of life.