内镜下支架置入术与外科手术治疗恶性幽门梗阻的对比研究  

Comparison of endoscopic stenting and surgical gastrojejunostomy for palliation of malignant gastric outlet obstruction

作　　者：朱叶[1] 王坤[1] 朱先兰 施瑞华[1] 杨树平[1] 冯亚东[1] 于莲珍[1] 

机构地区：[1]南京医科大学第一附属医院消化科,南京210029

出　　处：《中华消化内镜杂志》2015年第6期391-394,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的比较内镜下支架置入术和外科手术治疗恶性幽门梗阻的患者的优缺点。方法回顾性分析2007年至2014年因恶性幽门梗阻接受支架治疗的29例患者和外科手术治疗的42例患者资料，比较支架及外科手术的成功率，以及2组患者术后进食、并发症、住院时间和费用等情况。结果幽门支架与外科手术均能有效恢复患者进食，治疗前后的GOOSS评分相比差异均有统计学意义（P〈0．05），但支架组评分提高速度快于手术组。支架组与手术组的技术成功率均为100％，临床成功率分别为96．6％和92．9％，2组成功率差异无统计学意义（P值均≥0．05）。支架组早期并发症发生率低于手术组（3．4％比23．8％，P〈0．05），晚期并发症高于手术组（24．1％比6．9％，P〈0．05）；支架组主要并发症多为再梗阻，手术组则是感染、吻合口瘘；主要并发症的发生率2组无明显差异（27．6％比11．9％，P〉0．05）。支架与手术相比术后开始进食时间、住院时间和费用均有明显降低（P值均〈0．05）。结论内镜下支架置入术和外科手术均能有效缓解恶性幽门梗阻患者的症状，但支架治疗恢复进食快，住院时间短费用低，早期并发症少且晚期并发症大多可内镜下治疗，对预期生存期较短的患者来说是更好的选择。Objective To compare surgical gastrojejunostomy and endoscopic stenting in palliation of malignant gastric outlet obstruction. Methods This retrospective study investigated patients treated for malignant gastric outlet obstruction from January 2007 to January 2014 in the first affiliated hospital of Nan- jing Medical University. Endoscopic stenting was placed in 29 patients and surgical gastrojejunostomy was performed in 42 patients. The outcomes assessed included diet scores, time to diet, length of hospital stay, treatments fees and complications. Results Both endoscopic stenting and surgical gastrojejunostomy can re- lieve patients＇ syndrome with significant higher GOOSS score compared with that before treatment （ P 〈 O. 05 ）, but score improves faster in stenting group. Clinical success for endoscopic stenting and surgical gas- trojejunostomy was 96. 6% and 92. 9% respectively, and technical success was 100% for both of them. Endoscopic stenting group was found to have lower early complication rate（ 3.4% VS 23.8%, P 〈 0. 05 ）, higher late complication rate（24. 1% VS 6. 9%, P 〈0. 05）, less time to diet, hospital stay and treatment fees（ all P value 〈 O. 05 ） than surgical gastrojejunostomy group. The major complication after endoscopic stenting is re-obstruction while it is infection and leak of anastomotic site for surgical group. There were no significant differences in complication between two groups （27.6% VS 11.9%, P 〉 0. 05 ）. Conclusion Both endoscopic stenting and surgical gastrojejunostomy can relieve patients＇ syndrome effectively and safely, but endoscopic stenting improves GOOSS scores more rapid with less time to diet, less early complication rate and easy-dealing late complications, also it needs less hospital stay and fees. It＇s a better choice for patients with less survival expectation.

关 键 词：幽门梗阻 并发症 支架 内镜治疗 外科手术 

分 类 号：R656[医药卫生—外科学]