经内镜金属支架治疗胃出口梗阻的疗效评价

目的评价经内镜金属支架治疗胃出口梗阻的临床价值。方法1999年3月至2009年7月，我院内镜中心采用内镜金属支架治疗胃出口梗阻77例，评价手术成功率、并发症和远期疗效。结果共77例患者，男43例，女34例，年龄24—90（65±14）岁。其中晚期胃窦癌24例，胃癌术后复发19例（其中毕Ⅰ式吻合10例），十二指肠癌7例，壶腹周围癌7例，转移性肿瘤20例。支架置入成功率为93．5％（72，77），59例（81．9％）在支架置入1．3d后开始流质饮食，进食半流质的时间为4～9（5±3）d，其中52例（72．2％）患者在支架置入10～16（13±3）d后开始普通饮食。并发症包括疼痛（15.3％）、支架移位（2．8％）、出血（22．2％）。截至2009年8月30日，获随访率94．8％（73／77），中位生存期135（13～336）d。7例患者出现了再狭窄，支架通畅率90．3％（65／72），再次置入金属支架后好转。结论内镜下金属支架引流术是治疗胃出口梗阻的一种微创且安全有效的方法。

Endoscopic self-expanded metal stent for gastric outlet obstruction: ten years experience

Objective To evaluate the effect of endoscopic self-expanded metal stent for gastric outlet obstruction. Methods From March 1999 to July 2009, 77 cases of gastric outlet obstruction were treated by endoscopic self-expanded metal stent. The achievement ratio, complication incidence and long-term effect were evaluated. Results In 77 cases, male：female was 43：34, 24-90 （ 65 ± 14 ） years of age. Twenty-four cases were troubled with gastric cancer, 19 cases with recurrence after operation, 7 eases with duodenal carcinoma, 7 cases with peri-ampullae carcinoma and 20 with metastasis cancer. The achievement ratio was 93.5%（72/77）, 59 cases （81.9%） could take liquid diet 1-3 days after operation, semifluid diet 4-9（5 ±3） days later, and 52 cases（72.2%） began to take full diet after 10-16（13 ± 3） days. The main complication included pain（15.3%）, stent shift（2.8%）, bleeding（22.2%）. Until August 30, 2009, 73 cases （94.8%） were followed up, the median survival time was 135 （13-336） days. 7 cases happened re-stenosis and were treated by another metal stent. Conclusion Endoscopic self-expanded metal stent is a micro-invasie, safe, effective method for gastric outlet obstruction cases.