上胃肠道良恶性狭窄或阻塞的介入治疗  

Interventional procedure for benign and malignant stricture or obstruction of upper gastrointestinal tract

作　　者：程英升[1] 杨仁杰[2] 李明华[1] 尚克中[1] 陈维雄[3] 陈尼维[3] 储榆德[4] 庄奇新[1] 

机构地区：[1]上海市第六人民医院放射科,上海市200233 [2]北京医科大学临床肿瘤学院介入诊疗科,北京市100036 [3]上海市第六人民医院消化内科,上海市200233 [4]上海市第六人民医院胃肠镜中心,上海市200233

出　　处：《世界华人消化杂志》2000年第12期1354-1359,共6页World Chinese Journal of Digestology

基　　金：国家九五科技攻关基金资助课题;No.96-907-03-04~~

摘　　要：目的探讨上胃肠道良恶性狭窄或阻塞有效的介入治疗方法和它的优选法及其中远期疗效.方法上胃肠道(upper gastrointestinal tract,UGIT)良恶性狭窄或阻塞患者120例,其中 UGIT 良性狭窄球囊导管扩张术组(A 组)35例;UGIT 恶性狭窄或阻塞永久性无膜和带膜或部分带膜金属支架扩张组(B 组)35例;UGIT 良性狭窄永久性部分带膜金属支架扩张组(C 组)25例;UGIT 良性狭窄暂时性部分带膜金属支架扩张术组(D 组)25例.A 组在 X 线引导下行球囊扩张;B 组、C 组和 D 组在 X 线引导下放置部分带膜和无膜金属支架,D 组在支架术后3d～7d 由内镜取出.所有患者治疗前吞咽困难评分2～4级.结果 A 组35例共进行67次球囊扩张,平均1.9次.B 组35 例安放无膜或部分带膜金属支架35只 C 组25例安放部分带膜金属支架15只;无膜金属支架10只.D 组25例安放部分带膜金属支架25只.B,C 和 D 组支架置入成功率100%;D 组支架取出成功率100%.A 组 UGIT 管腔最窄处直径术前为(3.1±1.7)mm,术后为(8.9±3.3)mm;吞咽困难评分术前为(2.7±1.2)级,术后为(1.1±0.4)级;并发症发生率为疼痛29%(10/35)、反流23%(8/35)、出血9%(3/35);超过1a 的随访患者中91%(32/35)复发吞咽困难.B 组 UGIT 管腔最窄处直径术前为(2.9±2.5)mm,术后为(17.3±2.5)mm;吞咽困难评分术前为(3.1±0.5)级,术后为(1.6±0.7)级;并发症发生率为疼痛20%(7/35)、反流9%(3/35)、出血14%(5/35)、支架移位6%(2/35);超过6mo 的随访患者中17%(6/35)复发吞咽困难,超过1a 的随访患者中50%(15/30)复发吞咽困难.C 组UGIT 管腔最窄处直径术前为(3.1±2.4)mm,术后为(17.7±2.1)mm;吞咽困难评分术前为(2.5±1.1)级,术后为(0.5±0.3)级;并发症发生率为疼痛40%(10/25)、反流60%(15/25)、出血12%(3/25)、支架移位16%(4/25);超过6mo 的随访患者中20%(5/25)复发吞咽困难,超过1a 的随访患者中25%(3/12)复发吞咽困难.D 组 UGIT 管腔最窄处直径术前为(3.3±2.2)mm,术�AIM To study the effective method and optimized selection of interventional procedure and to evaluate mid and long-term therapeutic efficiency of stricture or obstruction of upper gastrointestinal tract(UGIT). METHODS There were benign and malignant stricture or obstruction of UGIT(120 cases)with interventional procedure,including 35 cases of benign stricture of UGIT cases with pneumatic dilation(group A)and 35 cases of malignant stricture or obstruction of UGIT,with permanent placement of covered or partially covered expandable metallic stent(group B),and 25 cases of benign stricture of UGIT with permanent(group C)and temporary(group D)placement of expandable metallic stent respectively.All cases were completed under fluoroscopy.Dysphagia scores of all cases were from grade 2 to 4. RESULTS Group A(n=35)had 67(mean 1.9)times dilations.The mean diameter of most strictured UGIT was 3.1 mm±1.7 mm before and 8.9 mm±3.3 mm after stent placement.The mean dysphagia scores were 2.7±1.2 grades before and 1.1±0.4 grades after stent placement. Complications in group A were chest pain(n=10),reflux (n=8)and bleeding(n=3).Thirty-two(91%)patients had dysphagia relapse during 12 months follow-up. Expandable metallic stents were permanently placed in group B(n=35).The mean diameter of most strictured UGIT was 2.9 mm±2.5 mm before and 17.3 mm±2.5 mm after stent placement.The mean dysphagia scores was 3.1±0.5 grades before and 1.6±0.7 grades after stent placement.Complications in group B were chest pain(n =7),reflux(n=3),bleeding(n=5)and stent migration (n=2).Six(17%)patients had dysphagia relapse during 6 months follow-up,15(50%)patients had dysphagia relapse during 12 months follow-up.In group C,the mean diameter of most strictured UGIT was 3.1 mm±2.4 mm before and 17.7 mm±2.1 mm after stent placement.The mean dysphagia scores was 2.5±1.1 grades before and 0.5±0.3 grades after stent placement.Complications in groupC were chest pain(n=10),reflux(n=15), bleeding(n=3)and stent migration(n=4).Five(20%) patients had dyspha

关 键 词：上胃肠道狭窄 介入治疗 适应证 

分 类 号：R57[医药卫生—消化系统]