侧视内镜联合X线置入胃十二指肠及空肠金属支架治疗消化道恶性梗阻的临床观察

目的探讨侧视内镜联合X线监视下肠道金属支架置入,治疗胃出口、十二指肠及空肠恶性梗阻的临床价值。方法回顾性分析23例胃出口、十二指肠及空肠恶性梗阻部位与肠腔严重成角的患者。经十二指肠侧视内镜置入导丝,联合X线监视下置入并释放自膨式肠道金属支架。结果 23例患者共置入金属支架28枚,全部成功。其中5例因肿瘤生长至再狭窄,而再次置入半覆膜金属支架。置入成功率100.0%。1例胆道支架后再放置十二指肠支架的患者出现一过性胆红素升高,未发生消化道穿孔及其他严重并发症。所有患者支架置入后24 h梗阻症状缓解或消除。随访时间3～12个月,所有患者均保持支架通畅。结论侧视内镜联合X线放置胃十二指肠及空肠金属支架,较前视内镜联合X线方法对恶性梗阻部位与肠腔严重成角的患者置入难度及风险减轻,成功率高,操作精准,并发症少。

Clinical application of gastric outlet, duodenum and jejunum metal stents placement under lateral endoscopy and X-ray monitoring

Abstract: Objective To explore the clinical value of metal stent implantation under lateral endoscopy and X-ray monitoring in treatment of malignant obstruction of gastric outlet, duodenum and jejunum. Methods 23 patients with malignant obstruction of gastric outlet, duodenum and jejunum were retrospectively analyzed, including 13 males and 10 females, aged 53 ~ 82 years, with an average age of 68.7 years. There were 12 gastric tumors, 5 pancreatic tumors, 3 ampulla abdominal tumors, 1 gallbladder cancer, 1 bile duct cancer and 1 duodenal cancer. All patients were diagnosed with malignant tumors by endoscope or surgical pathology. There were 12 cases of pyloric antrum and residual stomach obstruction, 8 cases of lower duodenal bulb and descending part obstruction, 3 cases of horizontal duodenal and proximal empty intestinal obstruction. The obstruction site was confirmed by gastroscopy, abdominal plain radiograph, upper gastrointestinal radiography, CT and MRI and so on. And there was a serious Angle between the narrow part and the expanded intestinal cavity. The guide wire was implanted through duodenal lateral endoscope, and the self-expanding intestinal metal stent was released under X-ray monitoring. Results 28 metal stents were all implanted successfully in 23 patients. The tumor in 5 cases grew to restenosis and re-implanted with semi-covered metal stents. The placement success rate was 100%. One patient with duodenal stent biliary followed by stent showed transient bilirubin elevation. No gastrointestinal perforation or other serious complications occurred. All patients were relieved or relieved of obstruction symptoms after 24 hours stent implantation. During the follow-up period of 3 ~ 12 months, all stent were maintained patency. Conclusion Malignant obstruction of gastric outlet, duodenum and jejunum which were serious Angle between the narrow part and the expanded intestinal cavity. Duodenal lateral endoscope joint X-ray placed in stomach, duodenum and jejunum metal stents can improve the success rate relieving visual endoscopy combined X-ray method.