内镜支架置入与手术治疗不可切除胃癌引起幽门梗阻的疗效对比  

Endoscopic stenting versus surgery for palliative therapy of gastric outlet obstruction caused by unresectable gastric cancer

作　　者：黄天臣[1] 肖建安[1] 王青兵[1] 王雁军[1] 张勇[1] 白东晓[1] 冯留顺[2] 

机构地区：[1]安阳市肿瘤医院普外科,河南省455000 [2]郑州大学第一附属医院普通外科

出　　处：《中华普通外科杂志》2017年第10期820-823,共4页Chinese Journal of General Surgery

摘　　要：目的对比内镜下支架置入术与外科手术治疗胃癌引起幽门梗阻的临床效果。方法选取2002年6月至2012年6月安阳市肿瘤医院治疗的晚期胃癌伴幽门梗阻患者133例，其中支架组63例，手术组70例。结果支架组和手术组的手术成功和临床成功率相比差异无统计学意义（P〉0．05）。支架组恢复经口进食时间和住院时间短[（2．5±3．1）d比（6．6±3．5）d，t=-7．0，P〈0．001；（6．7±5．9）d比（11．1±10．1）d，t=-3．0，P〈0．01]。手术组早期并发症多，晚期并发症少（P〈0．05）。手术组的通畅持续时间f（295．8d，95％CI：260．7～330．8d）比（168．2d，95％CI：134．7～201．7d），P〈0．001]和生存时间[（307．6d，95％CI：272．4—342．8d）比（229．6d，95％CI：195．1～264．3d），P=0．003]长于支架组。在ECOG评分为0～2分患者，支架组的通畅持续时间短于手术组（P=0．001），支架组的生存时间与手术组相比差异无统计学意义（P=0．164）。结论内镜下支架置入术和外科手术均能有效解决幽门梗阻。内镜下支架置入术后短期效果更好，外科手术解除梗阻后持续通畅时间更长。Objective To compare endoscopic stenting with surgery for pyloric obstruction caused by unreseetable gastric cancer. Methods Between June 2002 and June 2012, 6 patients underwent endoscopic stenting and 70 did surgery for gastric outlet obstruction caused by gastric cancer. Results There were no significant difference in technical success rate and clinical success rate between the stenting and surgery groups （ P 〉 0. 05 ）. The stenting group had shorter time to oral intake, and shorter length of hospital stay [（2.5±3.1）dvs. （6.6±3.5）d, t= -7.0, P〈0.001]. The incidence of early complications was significantly higher in the surgery group. However, the rates of late complications were significantly lower in the surgery group. Moreover, the surgery group was significantly associated with a longer pateney duration [ （295.8 d,95% CI：260. 7 - 330. 8） vs. （ 168.2 d,95% CI： 134. 7 - 201.7 d）, P 〈 0. 001 ] and overall survival [ （ 307.6 d, 95% CI： 272.4 - 342. 8 d） vs. （229. 6 d, 95% CI： 195.1 - 264. 3 d）, P = 0. 003 ]. Conclusions Both endoscopic stenting and surgery are effective palliative therapy for gastric outlet obstruction caused by gastric cancer. Endoscopic stenting is associated with better shortterm outcomes, Surgery is preferable to ES in longer pateney duration.

关 键 词：胃肿瘤 支架 幽门 

分 类 号：R735.2[医药卫生—肿瘤]