内镜超声引导下双旁路手术治疗恶性胃流出道梗阻合并胆道梗阻的疗效分析(含视频)  

Therapeutic value of double endoscopic bypass for malignant gastric outlet obstruction and biliary obstruction(with video)

作　　者：沈珊珊[1] 李雯[1] 蔡薇[1] 周晓亮[1] 吕瑛[1] 邹晓平[1] 王雷[1] Shen Shanshan;Li Wen;Cai Wei;Zhou Xiaoliang;Lyu Ying;Zou Xiaoping;Wang Lei(Department of Gastroenterology,The Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院消化内科,南京210008

出　　处：《中华消化内镜杂志》2022年第4期290-294,共5页Chinese Journal of Digestive Endoscopy

基　　金：国家自然科学基金中德合作项目(M-0251);国家自然科学基金面上项目(82072652)。

摘　　要：目的评价恶性胃流出道梗阻合并胆道梗阻行内镜超声引导下双旁路手术,即内镜超声引导下胃肠吻合术(endoscopic ultrasound-guided gastroenterostomy,EUS-GE)联合内镜超声引导下胆管引流术(endoscopic ultrasound-guided biliary drainage,EUS-BD)的疗效和安全性。方法收集2017年8月-2020年10月期间,病理确诊恶性肿瘤且合并胃流出道梗阻及胆道梗阻,无法进行外科手术及常规经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)治疗,在南京大学医学院附属鼓楼医院消化内科接受内镜超声引导下双旁路手术治疗的10例患者资料。回顾性分析双旁路治疗的完成情况(技术成功)、治疗效果(临床成功)和并发症发生等情况。结果10例EUS-GE和EUS-BD均获得技术成功,手术时间(60.5±22.3)min(30~100 min),术后无并发症出现。10例EUS-GE均获得临床成功;10例EUS-BD中,9例获得临床成功,1例未达到临床成功标准。术后随访37~120 d,中位随访71 d,10例患者均未出现胃流出道梗阻复发和胆道梗阻复发。结论对于无法进行外科手术及ERCP治疗的恶性胃流出道梗阻合并胆道梗阻患者,内镜超声引导下双旁路手术治疗是安全和有效的。Objective To evaluate the safety and feasibility of double endoscopic bypass,namely endoscopic ultrasound-guided gastroenterostomy(EUS-GE)combined with endoscopic ultrasound-guided biliary drainage(EUS-BD),for malignant gastric outlet and biliary obstruction.Methods A retrospective analysis was conducted on data of 10 patients with malignant gastric outlet and biliary obstruction who were not suitable for surgery or endoscopic retrograde cholangiopancreatography(ERCP)and treated by double endoscopic bypass in Nanjing Drum Tower Hospital from August 2017 to October 2020.The completion of therapy,clinical efficacy and post-procedure adverse events were analyzed.Results Ten patients with different malignant cancer successfully underwent EUS-GE and EUS-BD,with procedure time of 60.5±22.3 min(30-100 min).There were no postoperative adverse events.EUS-GE was elinically successful in all 10 cases.0f the 10 EUS-BD cases,9 were clinically suecessful,and I did not meet the criteria of clinical success.The median ollow-up was 71(37-120)days.None of the 10 patients had recurrent gastrie outflow traet obstruction or biliary tract obstruction.Conclusion Double endoscopie bypass is feasible and ffective for patients with malignant gastric outlet and biliary obstruction and without surgery or ERCP opportunity.

关 键 词：胃出口梗阻 胆道梗阻 内镜超声引导下胃肠吻合术 内镜超声引导下胆管引流术 

分 类 号：R735[医药卫生—肿瘤]