经内镜放置金属支架联合肿瘤局部植入化疗药物治疗胃出口恶性梗阻的研究  

Endoscopic placement of metal stent implantation of tumor local chemotherapy for malignant obstruction of gastric outlet

作　　者：王志勇[1] 孙丽伟[1] 吴建良[1] 李丽[1] 马菊妹[1] 胡娇娣[1] 

机构地区：[1]杭州师范大学医学院附属医院杭州市第二人民医院消化科,浙江杭州310015

出　　处：《中外医学研究》2010年第15期4-6,共3页CHINESE AND FOREIGN MEDICAL RESEARCH

基　　金：浙江省医药卫生科学研究基金计划（B类）2007B176

摘　　要：目的 探讨经内镜放置金属支架联合肿瘤局部植入化疗药物治疗胃出口恶性梗阻的疗效.方法 进展期胃癌幽门梗阻患者33例,随机分成三组,既单纯幽门支架植入组（支架组）9例：经内镜直视下放置支架,选用特制幽门支架及十二指肠支架,少数为食道支架;幽门支架植入联合肿瘤局部注射化疗药物联合组（联合组）9例：先放置支架,患者休息片刻后再次插镜,根据肿瘤大小和范围,注射5-氟尿嘧啶500 mg和丝裂霉素4 mg,深度0.5～1.0 cm;另选择同期拒绝任何治疗的患者作为对照组15例：只予静脉或口服药物综合支持治疗.分别与第4、8、12周分别复查胃镜及疗效判定.结果本组18例支架放置皆1次成功,其中放置特制幽门支架5例,十二指肠支架10例,食道支架3例,术后24～48 h摄片示支架膨胀约90%,术后24 h恢复进流食,常见并发症是恶心、呕吐,上消化道出血和上腹疼痛等.随访3个月,无支架移位,脱落.支架组、联合组、对照组平均通畅期分别为53.4 d、72.33 d、23.6 d;支架组与对照组比较,联合组与支架组比较其通畅期明显长,差异具有非常显著统计学意义（P〈0.001）.结论 单纯植入支架组与支架植入联合局部注射化疗药物组疗效明显优于对照组,而联合组与支架组疗效比较,通畅期联合组明显长于支架组,说明支架植入联合局部注射化疗药物患者梗阻缓解的时间更长,更具优越性.Objective To evaluate the endoscopic placement of metal stent implantation of tumor local chemotherapy for malignant gastric outlet obstructions. Methods Patients with advanced gastric pyloric obstruction,33 cases were randomly divided into three groups, both pure pyloric stent group （stent group） in 9 eases： after endoscopic stent placement, stent use special pylorus and duodenum stent, a small number of stents for the esophagus;pyloric stent implantation with tumor tumor injection chemotherapy combined group （combined group） in 9 eases：the first stent, the patient again after a short break inserted mirror, according to tumor size and scope of the injection of 5 -fluorouracil 500 mg and wire mitomycin 4 mg,depth of 0. 5 - 1.0 cm;other options over the same period the patients refused any treatment, 15 cases as control group：only for intravenous or oral comprehensive support treatment. 4,8,12 weeks respectively, with the first endoscopy and efficacy were determined. Resalts 18 patients with stents are a successful, including special pylorie stent placement in 5 cases, 10 cases of duodenal stents, esophageal stents in 3 cases,24 - 48 h after photographs showed about 90% of stent expansion, operation 24 h after restoration of flow into the food, common complications are nausea, vomiting, upper gastrointestinal bleeding and abdominal pain. Follow - up 3 months, no stent migration, off. Stent group and combination group, the control group, the average patency period was 53.4 d,72. 33 d, 23.6 d;stent group compared with the control group, the combination group compared with the stent patency time was significantly longer, the difference was significant（ P 〈0. 001 ）. Conclusion Stent implantation of stent implantation with local injection of chemotherapy drugs were significantly better than the control group ,while the efficacy of the combination group compared with the stent group, patency was significantly longer than that of combined stent group, stent implantation shows chemotherapy combined wit

关 键 词：胃出口恶性梗阻 金属支架植入 局部注射 化疗药物 

分 类 号：R730.53[医药卫生—肿瘤]