无X线监视内镜下置入幽门支架治疗胃出口恶性梗阻36例  

Treatment of malignant gastric outlet obstruction by endoscopically implanting pyloric stents without fluoroscopic guidance:an analysis of 36 cases

作　　者：吴齐[1,2,3] 李士杰[1,2,3] 曹长琦[1,2,3] 张集昌[1,2,3] 

机构地区：[1]北京大学临床肿瘤学院 [2]北京肿瘤医院 [3]北京市肿瘤防治研究所恶性肿瘤发病机制及转化研究教育部重点实验室内镜中心,北京市100142

出　　处：《世界华人消化杂志》2011年第7期739-743,共5页World Chinese Journal of Digestology

摘　　要：目的:评价无X线监视内镜下置入幽门支架治疗胃出口恶性梗阻的操作技术、临床疗效及并发症.方法:对2007-01/2009-12接受无X线监视内镜下幽门支架置入治疗的36例胃出口恶性梗阻患者的临床资料进行回顾性分析.结果:36例患者共置入39枚支架,其中3例患者为双支架.7例患者因病变狭窄程度高,先行内镜下球囊扩张,再行支架置入.支架置入成功率100%.患者术后1wk及4wk的GOOSS评分高于术前,且差异具有统计学意义(P=0.000).患者GOOSS评分高于术前时间平均为101.3(7-380)d.患者平均生存期123.3(10-380)d.2例患者发生术后支架移位(20d及65d).2例患者术后因肿瘤向支架内浸润生长,致GO-OSS评分降低.1例患者术后7d发生急性胆管炎.无出血、穿孔病例.结论:无X线监视内镜下置入幽门支架治疗胃出口恶性梗阻是一种简单可行、安全有效的方法.AIM：To evaluate the feasibility,efficacy,and complications of endoscopic placement of pyloric stents without fluoroscopic guidance in patients with malignant gastric outlet obstruction.METHODS：The clinical data for 36 patients with malignant gastric outlet obstruction who underwent endoscopic placement of pyloric stents between January 2007 and December 2009 were analyzed retrospectively.RESULTS：Thirty-six patients received a total of 39 stents,one stent each in 33 patients and two stents each in three patients.In seven patients with high-grade stenosis,endoscopic balloon dilatation was performed before stent insertion.Successful stent implantation was achieved in all patients.The gastric outlet obstruction score system（GOOSS） score was significantly increased within 1 and 4 weeks after stent placement（P = 0.000）.The mean duration was increased 101.3 days（7-380 days）.The mean survival time was 123.3 days（10-380 days）.Device-related adverse events included stent migration（n = 2,day 20 and day 65）,stent occlusion caused by tumor inf iltration（n = 2）,and acute cholangitis（n = 1,day 7）.No hemorrhage or perforation occurred.CONCLUSION：Endoscopic implantation of pyloric stents without fluoroscopic guidance is a simple,safe and effective method for malignant gastric outlet obstruction.

关 键 词：胃出口梗阻 内镜 支架 

分 类 号：R735[医药卫生—肿瘤]