胃镜-X线联合金属内支架置入治疗胃十二指肠恶性梗阻的临床价值

Clinical observation of endoscopic X-ray combined with metal stent implantation in treatment of gastroduodenal malignant obstruction

目的探讨内镜直视联合X线监视下金属内支架置入治疗胃十二指肠恶性梗阻的临床价值。方法选择2013年1月-2015年12月该院消化内科收治的胃十二指肠恶性梗阻患者70例为研究对象,按照患者住院先后顺序编号,将奇数号患者纳入观察组,偶数号患者纳入对照组,每组患者35例。两组患者在内科基础治疗的前提下,观察组采用内镜直视联合X线监视下金属内支架置入,对照组采用单纯胃镜引导下金属内支架置入。记录两组患者手术操作时间,支架一次性置入成功率、准确率、覆盖病变、支架脱落/移位及并发症情况,并进行统计学分析。结果平均手术操作时间观察组(9.71±3.60)min,对照组(21.01±5.20)min;支架一次性置入成功率观察组97.14%,对照组77.14%;术后4周复查支架通畅率观察组97.14%,对照组74.28%;覆盖病变两组无明显差别。并发症:两组患者均出现少量出血,经处理后出血停止;观察组未见消化道溃疡,支架移位1例,胃肠道并发症1例,代谢并发症1例;对照组支架移位4例,胃肠道并发症6例,代谢并发症7例。结论胃镜-X线联合金属内支架置入治疗胃十二指肠恶性梗阻操作时间短、置入成功率高、支架定位准确、并发症少,存活时间长,是一种简单可行、安全有效的方法。

Objective To investigate the clinical value of endoscopic stent implantation combined with X-ray monitoring in the treatment of malignant gastroduodenal obstruction.Methods70cases of malignant obstruction of stomach and duodenum from January2013to December2015were enrolled.According to the patients'hospitalization sequence,the odd number of patients were enrolled in the study group,the even number of patients were enrolled in the control group,35cases in each.The difference is that the study group were performed in metallic stent placement under fluoroscopic monitoring and endoscopic direct vision,while the control group only under endoscopic direct vision.Record the operation time,the success rate and accuracy of disposable implantation,diseases,the displacement and falling of the stent,and complications.we statistically analyzed the data.Results The operation time of the intervention group on average was(9.71±3.60)min,while the control group was(21.01±5.20)min.The success rate and accuracy of disposable implantation of the intervention group was97.14%,while the control group was77.14%;After4weeks after stent patency rate were97.14%,74.28%in the control group;Two groups are with the same diseases.All of the patients had small amount of bleeding,which were stoped after treatment.There was no gastrointestinal ulcers,1case with stent displacement,1case with gastrointestinal complications,1ase with metabolic complications in the intervention group.There was4cases with stent displacement,6cases with gastrointestinal complications,7case with metabolic complications the control group.Conclusion Gastroscope-X-ray combined with metallic stent implantation in the treatment of malignant gastroduodenal obstruction,short operation time,high success rate,stent implantation of accurate positioning,less complications,long survival,is a kind of method is simple and feasible,safe and effective.