内镜下置入幽门支架治疗进展期胃窦癌胃出口梗阻疗效观察

Efficacy of Endoscopic Placement of Pyloric Stent for Gastric Outlet Obstruction due to Advanced Gastric Antral Cancer

背景：胃出口梗阻（GOO）是进展期胃癌的常见并发症，此类患者手术切除机会较低，生存期短，生活质量差。目的：评价内镜下置入幽门支架对进展期胃窦癌合并GOO的姑息治疗作用。方法：2012年1月～2013年5月宝山区中西医结合医院32例表现为不能进食或进食后呕吐，经上消化道造影证实存在G00并接受内镜下置入幽门支架治疗的进展期胃窦癌患者纳入研究。治疗前后以GOO记分系统（GOOSS）和焦虑自评量表（SAS）、抑郁自评量表（SDS）评价患者的梗阻情况和心理状态，观察术后并发症发生情况。结果：32例患者均成功置入支架且膨胀良好，术后1周和4周GOOSS评分较术前明显增高，SAS、SDS评分较术前明显降低，差异均有统计学意义（P〈0．05）。1例患者发生支架移位，2例发生支架阻塞，未见穿孔和明显出血病例。结论：对于不能手术的进展期胃窦癌合并G00，内镜下置入幽门支架是一种微创、安全、有效的姑息治疗方法，可缓解梗阻症状，改善患者的焦虑、抑郁倾向。

Background： Gastric outlet obstruction （GOO） is commonly seen in patients with advanced gastric cancer. Patients with malignant GOO are usually inoperable with a short remaining lifespan and a poor quality of life. Aims ： To evaluate the palliative effect of endoscopic placement of pyloric stent for malignant GOO in patients with advanced gastric antral cancer. Methods： From Jan. 2012 to May 2013, 32 cases of advanced gastric antral cancer patients presenting with unable to take food and intractable emesis were treated with endoscopic placement of pyloric stent in Baoshan Hospital of Integrated Traditional Chinese and Western Medicine. Malignant GOO was confirmed by contrast gastroenterography in all 32 patients. GOO scoring system （GOOSS） , self-rating anxiety and depression scales （SAS and SDS） were employed to assess the pre- and post-procedure obstruction and mental status. Post-procedure complications were observed. Results： Successful stent placement and deployment was achieved in all 32 patients. GOOSS score was increased within 1 and 4 weeks after the stent placement, while scores of SAS and SDS were decreased. Differences between the pre- and post-procedure parameters were statistically significant （P 〈 0.05）. Stent migration occurred in 1 patient and stent obstruction occurred in 2 cases. No procedure-related perforation and obvious bleeding were observed. Conclusions： Endoscopic placement of pyloric stent is a safe and effective minimally invasive palliative treatment modality for malignant GOO in patients with inoperable advanced gastric antral cancer. It might be beneficial for relieving obstruction and anxious and depressed mental status.