X线引导内镜下胃空肠支架吻合术的临床探讨(含视频)

Clinical value of X-ray guided endoscopic gastrojejunostomy using stent(with video)

目的初步评估X线引导普通内镜下胃空肠支架吻合术治疗恶性胃流出道梗阻的疗效及安全性。方法2017年3月至2017年6月,肿瘤晚期所致胃流出道梗阻,在山东大学附属省立医院消化内科住院,并行X线引导普通内镜下胃空肠支架吻合术治疗的6例患者纳入回顾性分析,总结技术成功率、临床成功率、操作时间、并发症发生情况以及随访情况。结果6例支架均成功放置且位置良好、通畅,技术成功为100%(6/6),操作时间为(91.7±51.8)min,术后均可进流质或半流质饮食,胃流出道梗阻评分系统评分由术前的0~1分提高至术后的2~3分,临床有效率为100%(6/6)。2例术中合并腹膜炎,术后给予超声引导下腹腔穿刺置管引流及腹腔冲洗,2d内腹腔积液及腹膜炎症状消失;1例术后出现消化道出血,经内镜证实为支架头端的胃壁溃疡出血,经保守治疗后好转。随访32~100d,平均78.6d,除1例术后60d死于肿瘤进展、肾功能衰竭外,其余5例均可进流质或半流质饮食,未出现梗阻症状复发。结论X线引导普通内镜下胃空肠支架吻合术治疗恶性胃流出道梗阻安全可行,短期疗效可靠。

ObjectiveTo evaluate the efficacy and safety of X-ray guided endoscopic gastrojejunostomy using stent in treatment of malignant gastric outlet obstruction(GOO).MethodsSix hospitalized patients with malignant GOO underwent X-ray guided endoscopic gastrojejunostomy using stent in the department of gastroenterology,Shandong Provincial Hospital Affiliated to Shandong University between March 2017 and June 2017.The technical success rate,clinical success rate,procedure time,adverse events and follow-up were recorded and analyzed in this retrospective study.ResultsThe stent was successfully placed in the 6 patients with 100%(6/6)technical success rate.The mean procedure time was 91.7±51.8 min.After the procedure,all patients were fed liquid or semi-liquid diet,and the GOO score system was increased from 0-1 before operation to 2-3 after operation.The clinical success rate was 100%(6/6).Peritonitis was observed in 2 patients during operation,and resolved by abdominal drainage.Gastrointestinal bleeding occurred in 1 patient after operation,which was resolved with conservative treatment.During a mean follow-up period of 78.6 days(range 32-100 days),there was no recurrence of obstruction symptoms except that 1 patient died because of tumor progress 60 days after procedure.ConclusionThe X-ray guided endoscopic gastrojejunostomy using stent is feasible and safe to treat malignant GOO with a reliable short-term efficacy.