超声内镜引导胃空肠吻合术在治疗胃出口梗阻患者中的应用效果

Application of endoscopic ultrasound-guided gastroenterostomy in treatment of gastric outlet obstruction

目的 探讨并总结超声内镜引导胃空肠吻合术(EUS-GE)治疗胃出口梗阻(GOO)患者的应用效果。方法 回顾性分析2017年3月-2021年6月该院77例因GOO行EUS-GE的患者的临床资料,关注术前评估及胃排空准备,统计分析EUS-GE术后的临床治疗效果、并发症发生率及患者生命质量改善情况。结果 77例患者均成功行EUS-GE,术后GOO评分由术前0至1分提高到术后1至3分;欧洲癌症研究与治疗组织的生命质量核心量表(EORTC QLQ-C30)中整体健康状况评分由术前的(6.94±1.04)分提高到(10.39±1.11)分(P<0.01);术后2例患者支架不通畅,2例支架移位,2例消化道出血,3例并发轻症急性胰腺炎,35例因术中主动穿孔出现肠瘘伴发热,经过对症治疗后,患者均恢复良好,顺利出院。结论EUS-GE具有疗效好、创伤小和手术成功率高等优点,术后能有效改善GOO情况,提高患者生命质量,但术后并发症多,有效的术前评估及术后观察可减少术后并发症的发生。

Objective To explore and summarize the therapeutic effect of patients with gastric outlet obstruction(GOO)treated by endoscopic ultrasound-guided gastroenterostomy(EUS-GE).Method The clinical data of 77 patients who underwent EUS-GE due to GOO from March 2017 to June 2021 were retrospectively analyzed.Attention was paid to preoperative assessment and preparation for gastric emptying,the clinical treatment effect,complication rate and improvement of patients’quality of life after EUS-GE were statistically analyzed.Result All the 77 patients underwent EUS-GE successfully.The score of postoperative GOO increased from 0 or 1 to 1 or 3;European Organization for Research and Treatment for Cancer quality of life questionnaire-core 30(EORTC QLQ-C30)increased from(6.94±1.04)to(10.39±1.11)(P<0.01);After operation,2 patients had stent obstruction,2 patients had stent displacement,2 patients had gastrointestinal bleeding,3 patients had mild acute pancreatitis,and 35 patients had intestinal fistula with fever due to active perforation during operation.After symptomatic treatment,all patients recovered well and were discharged smoothly.Conclusion EUS-GE has the advantages of good curative effect,less trauma and high success rate.It can effectively improve the GOO and improve the patients’ quality of life. However, there are many postoperative complications. Effective preoperative evaluationand postoperative observation can reduce the incidence of postoperative complication.