内镜下支架置入术和外科手术治疗十二指肠恶性狭窄的临床疗效

Clinical efficacy of endoscopic stenting and surgical treatment for malignant duodenal stenosis

目的评价X射线下经内镜放置钛镍记忆合金自膨式支架对十二指肠恶性狭窄的临床效果。方法收集2012年1月至2021年4月在中国人民解放军联勤保障部队第九四〇医院消化内科住院并已发生周围病变浸润及肝或肺转移的十二指肠癌患者67例,其中29例自愿进行胃-空肠吻合姑息手术作为手术组,38例不愿手术行支架置入者为支架组,在X射线下经内镜放置钛镍记忆合金自膨式支架。观察支架组自膨式支架置入成功率,比较两组肠道梗阻改善情况、生活质量状况、生存时间、不良反应以及平均住院时间。结果支架组的支架放置成功率为97.4%,其狭窄程度明显改善,患者生活质量提高,生存时间延长,与手术组相比差异无统计学意义(P>0.05)。支架组平均住院时间为5 d,手术组平均住院时间为12 d,支架组的不良反应明显少于手术组。结论X射线下经内镜放置钛镍记忆合金自膨式支架能有效解决十二指肠恶性狭窄,具有创伤小、并发症少、简单、安全、费用低等优点。

Objective To evaluated the clinical effect of endoscopic placement of titanium-nickel memory alloy self-expanding stent on malignant duodenal stenosis under X-ray.Methods Sixty-seven patients with duodenal carcinoma who had peripheral lesion infiltration and liver or lung metastasis in Department of Gastroenterology,the 940th Hospital of Joint Service Logistics Support Force of PLA,from Jan.2012 to Apr.2021 were collected,of which 29 patients volunteered for palliative operation of gastrojejunal anastomosis as the operation group and 38 patients who refused surgery and underwent stent implantation as the stent group.Titanium-nickel memory alloy self-expanding stent was placed under X-ray endoscopy.The success rate of self-expanding stent implantation in the stent group was observed,and the improvement of intestinal obstruction,quality of life,survival time,side effects and average hospital stay were compared between the two groups.Results The success rate of stent placement in the stent group was 97.4%.The degree of stenosis was significantly improved.The quality of life in patients was improved,and the survival time was prolonged.There was no significant difference compared with the operation group(P>0.05).The average hospital stay in the stent group was 5 days,and the average hospital stay in the operation group was 12 days.The side effects in the stent group were also significantly less than those in the operation group.Conclusion Endoscopic placement of titanium-nickel memory alloy self-expanding stent under X-ray can effectively solve the malignant duodenal stenosis.It has the advantages of less trauma,less complications,simplicity,safety and low cost.