胃十二指肠恶性梗阻金属内支架治疗的方法探讨  

The Technique of Metallic Self--expanding Stents in Treating Malignant Gastroduodenal Obstruction

作　　者：魏欣[1] 钟立明[1] 胡鸿[1] 游箭[1] 任大成[2] 胡欣[2] 潘荣强[2] 

机构地区：[1]川北医学院第二临床学院南充市中心医院医学影像科介入医学中心,四川南充637000 [2]川北医学院第二临床学院南充市中心医院肿瘤科,四川南充637000

出　　处：《实用放射学杂志》2010年第2期255-257,共3页Journal of Practical Radiology

摘　　要：目的探讨金属内支架治疗不能手术的胃十二指肠恶性梗阻的方法和疗效。方法回顾分析9例胰头癌和6例胃癌所致胃十二指肠梗阻患者行金属内支架置入术的资料，分析内支架置人治疗中的操作要点以及影响术后疗效的因素。结果①患者术中体位因人而异，因时而异；②经导管注入空气撑开胃腔有利于插管操作；③采用7F指引导管可减少与超硬导丝之间的相对摩擦力；④医生通常在全视野近距离透视下操作，所受辐射剂量较大；⑤插入超长超硬导丝过程中，根据张力将导管导丝联合后撤可减少导丝盘曲；⑥调整超长超硬导丝走向与胃腔形态相符合有利于插入释放器；⑦影响术后疗效的主要因素为病变位置特点、患者饮食习惯及疾病发展转归，患者的死亡原因主要为转移和全身衰竭。结论关注手术操作的细节和要点是成功实施金属内支架治疗胃十二指肠恶性梗阻的关键，肿瘤的发展转归是影响疗效的决定因素。Objective To explore the methods and curative effect of metallic self--expanding stent in inoperable malignant gastroduodenal obstruction. Methods The data of 15 cases with gastroduodenal obstruction including 9 cases of carcinoma of head of pancreas and 6 cases of carcinoma of stomach were analyzed retrospectively. The operative procedures of the stent implanted and the influence factors of curative effect were analysed. Results （1）The positions of patients were different according to the individual difference and operative procedure. （2）The operation of transeatheter injecting air to expand gastral cavity profited to plug in catheter. （3）The 7F guiding catheter could decrease the relative friction between the catheter and the ultralong stiff guide wire. （4）The doctors accepted more radiation dose because the manipulation was under the fluoroscopy in a short distance and with a full field of view. （5）In the procedure of plug in ultralong stiff guide wire, to withdraw the catheter and guide wire simultaneously according to the tension could decrease the bending of guide wire. （6）The operation of adjusting the path of ultralong stiff guide wire to match the shape of gastral cavity profited to plug in stent releaser. （7）The main reasons to influence the curative effect included the position of the lesions, the postoperative eating habit and the development turnover of disease. The main death reasons were tumor transfer and system exhaustion. Conclusion To pay close attention to the details and main points of operative procedure is the key point to implant stent successfully for malignant gastroduodenal obstruction. The determinative factor to influence the curative effect is the development turnover of tumor.

关 键 词：胃十二指肠恶性梗阻 金属内支架 介入放射学 

分 类 号：R573.9[医药卫生—消化系统] R815[医药卫生—内科学]