内镜结合X线下金属支架置入术治疗胃十二指肠恶性梗阻32例临床研究  

Clinical analysis of 32 cases of malignant stenosis of gastric outlet or duodenal treated by implanting stent under endoscopy and fluoroscopic guidance

作　　者：赵振涛[1] 王健[2] 岳园[1] 

机构地区：[1]山东中医药大学第二附属医院特检科内镜室,250001 [2]山东中医药大学第二附属医院急诊科,250001

出　　处：《中国实用医药》2009年第3期84-86,共3页China Practical Medicine

摘　　要：目的探讨经内镜结合X线下金属支架置入术治疗胃出口、十二指肠恶性梗阻的临床价值。方法取32例胃出口恶性梗阻患者,行内镜检查后经活检孔置入导丝,X线监视下置入并释放自膨式金属肠道支架。结果32例患者均成功置入支架,成功率为100.0%,其中6例采取经内镜钳道(TTS)方式释放支架,26例为经导丝直接释放支架。支架置入后内镜和透视造影检查示支架均定位准确、通畅。所有患者均存在少量出血,12例予局部喷洒孟氏液止血,效果良好。31例支架放置后1～3d梗阻症状得到缓解或消除,临床有效率为96.9%,平均生存期4.8个月。1例术后1个月支架移位,1例术后2个月肿瘤向支架内浸润生长,导致梗阻复发,均予放置第2根支架后缓解。结论经内镜下放置金属支架治疗胃出口、十二指肠恶性梗阻是一种简单可行、安全有效的方法;结合X线操作具有提高置入成功率、缩短操作时间、支架定位准确以及减少患者痛苦和手术相关并发症的优点。Objective To evaluate the clinical value of metal stenting for malignant gastric outlet or duodenal obstruction, and to appraise the methods of implanting stents under endoscopy and fluoroscopic guidance. Methods 32 cases of malignant stenosis of gastric outlet or duodenal were usually examined by endoscopy at first, the guide wire was introduced through the biopsy channel, and the metallic stent was implanted under fluoroscopy. Results Stent insertion was technically successful in 32 patients （100. 0% ）, 4 stents were placed through the scope channel （TIS）, 26 stents were non-TrS placement. All stents were located precisely under endoscopy. All cases had small amount bleeding,and 12 cases were treated by local haemostasis. After stenting,31 patients showed relief of obstructive symptoms within 1-3 days, the clinical success rate was 96. 9%, the mean survival date was 4. 8 months. During the follow-up period, one patient had gastrointestinal bleeding, and was successfully treated by internal medication. Recurrent obstruction was observed in 2 cases, one with distal stentt migration one month after stent implantation, the other with tumor ingrowth at 2 months. The obstruction symptoms were relieved after second stent placement in these 2 cases. Conclusion Endoscopic placement of metal stent is simple, safe and effective method for palliation in patients with malignant gastric outlet and duodenal obstruction. Endoscopy and fluoroscopy can promote the success rate of implantation, the procedural duration is shortened, stent localization is precise and complications are few.

关 键 词：胃出口梗阻 十二指肠梗阻 内镜 支架 

分 类 号：R735[医药卫生—肿瘤]