经内镜胆道支架治疗梗阻性黄疸

目的：探讨梗阻性黄疸时塑料和镍钛记忆合金镀金网状支架内镜置入的操作技术及其临床疗效。方法：本组塑料支架组129例,包括：十二指肠乳头炎性狭窄28例,胆总管下段炎性狭窄16例,老年胆总管巨大结石11例,胆漏17例,胆管外科损伤狭窄10例,肝移植术后胆管吻合口狭窄34例,肝门部胆管狭窄8例,胰腺癌5例;镀金支架组42例,包括：中下段胆管癌15例,肝门部胆管癌8例,十二指肠乳头癌9例,胰腺癌10例。所有病人均行ERCP以证实狭窄部位及其程度,选择合适的支架。经十二指肠镜插入导丝至梗阻远端,狭窄明显者沿导丝进行球囊扩张;在x线监视下沿导丝用支架推送器将支架送至狭窄远端2cm。术后观察病人黄疸改善情况,同时观察肝功能、血清淀粉酶变化,并随访3-6月。结果：本组支架均一次置入成功,成功率200％。镍钛记忆合金网状支架置入后1周,患者血清总胆红素（STB）下降68.50％,谷丙转氨酶（ALT）下降64.37％,r-谷胺酰转肽酶（r-GT）下降51.12％,碱性磷酸酶（ALP）下降45.10％;塑料支架置入后1周,STB下降64.24％,ALT下降59.70％,r-GT下降52.83％,ALP下降44.61％。早期并发症包括：高淀粉酶血症、ERCP术后胰腺炎、胆管炎,晚期并发症有支架堵塞。镀金支架组随访期间有4例（14.29％）死于肿瘤进展。结论：经内镜塑料和镍钛记忆合金镀金网状支架治疗胆道梗阻性黄疸安全、有效、并发症少;塑料支架在胆漏及胆道损伤治疗中的应用为肝胆外科手术并发症的治疗提供了较好的弥补手段。     

胃镜直视下金属支架治疗58例胃内恶性梗阻

目的 探讨胃镜直视下置入镍钛记忆合金支架对胃内恶性梗阻的疗效和并发症发生的情况.方法 2006年1月至2008年10月对58例胃癌合并恶性不全性梗阻患者,在胃镜直视下置入镍钛记忆合金支架.结果 共置入27例贲门支架,5例胃体支架,26例胃窦幽门支架.胃镜直视下置入支架成功率100.0%(58/58),1个月后临床有效率93.1%(54/58).主要并发症为疼痛和粪隐血试验阳性,发生率分别为81.0%(47/58)和89.7%(52/58),经治疗后均缓解或消失,未发生与操作相关的严重并发症.结论 胃镜直视下镍钛记忆合金支架置入术治疗胃内恶性梗阻,是简单、有效的方法之一,大部分并发症是可以预防和治疗的.     

胃镜直视下金属支架治疗58例胃内恶性梗阻

目的 探讨胃镜直视下置入镍钛记忆合金支架对胃内恶性梗阻的疗效和并发症发生的情况.方法 2006年1月至2008年10月对58例胃癌合并恶性不全性梗阻患者,在胃镜直视下置入镍钛记忆合金支架.结果 共置入27例贲门支架,5例胃体支架,26例胃窦幽门支架.胃镜直视下置入支架成功率100.0%(58/58),1个月后临床有效率93.1%(54/58).主要并发症为疼痛和粪隐血试验阳性,发生率分别为81.0%(47/58)和89.7%(52/58),经治疗后均缓解或消失,未发生与操作相关的严重并发症.结论 胃镜直视下镍钛记忆合金支架置入术治疗胃内恶性梗阻,是简单、有效的方法之一,大部分并发症是可以预防和治疗的.     

胃镜直视下金属支架治疗58例胃内恶性梗阻

目的 探讨胃镜直视下置入镍钛记忆合金支架对胃内恶性梗阻的疗效和并发症发生的情况.方法 2006年1月至2008年10月对58例胃癌合并恶性不全性梗阻患者,在胃镜直视下置入镍钛记忆合金支架.结果 共置入27例贲门支架,5例胃体支架,26例胃窦幽门支架.胃镜直视下置入支架成功率100.0%(58/58),1个月后临床有效率93.1%(54/58).主要并发症为疼痛和粪隐血试验阳性,发生率分别为81.0%(47/58)和89.7%(52/58),经治疗后均缓解或消失,未发生与操作相关的严重并发症.结论 胃镜直视下镍钛记忆合金支架置入术治疗胃内恶性梗阻,是简单、有效的方法之一,大部分并发症是可以预防和治疗的.     

胃镜直视下金属支架治疗58例胃内恶性梗阻

目的 探讨胃镜直视下置入镍钛记忆合金支架对胃内恶性梗阻的疗效和并发症发生的情况.方法 2006年1月至2008年10月对58例胃癌合并恶性不全性梗阻患者,在胃镜直视下置入镍钛记忆合金支架.结果 共置入27例贲门支架,5例胃体支架,26例胃窦幽门支架.胃镜直视下置入支架成功率100.0%(58/58),1个月后临床有效率93.1%(54/58).主要并发症为疼痛和粪隐血试验阳性,发生率分别为81.0%(47/58)和89.7%(52/58),经治疗后均缓解或消失,未发生与操作相关的严重并发症.结论 胃镜直视下镍钛记忆合金支架置入术治疗胃内恶性梗阻,是简单、有效的方法之一,大部分并发症是可以预防和治疗的.     

胃镜直视下金属支架治疗58例胃内恶性梗阻

目的 探讨胃镜直视下置入镍钛记忆合金支架对胃内恶性梗阻的疗效和并发症发生的情况.方法 2006年1月至2008年10月对58例胃癌合并恶性不全性梗阻患者,在胃镜直视下置入镍钛记忆合金支架.结果 共置入27例贲门支架,5例胃体支架,26例胃窦幽门支架.胃镜直视下置入支架成功率100.0%(58/58),1个月后临床有效率93.1%(54/58).主要并发症为疼痛和粪隐血试验阳性,发生率分别为81.0%(47/58)和89.7%(52/58),经治疗后均缓解或消失,未发生与操作相关的严重并发症.结论 胃镜直视下镍钛记忆合金支架置入术治疗胃内恶性梗阻,是简单、有效的方法之一,大部分并发症是可以预防和治疗的.     

胃镜直视下金属支架治疗58例胃内恶性梗阻

目的 探讨胃镜直视下置入镍钛记忆合金支架对胃内恶性梗阻的疗效和并发症发生的情况.方法 2006年1月至2008年10月对58例胃癌合并恶性不全性梗阻患者,在胃镜直视下置入镍钛记忆合金支架.结果 共置入27例贲门支架,5例胃体支架,26例胃窦幽门支架.胃镜直视下置入支架成功率100.0%(58/58),1个月后临床有效率93.1%(54/58).主要并发症为疼痛和粪隐血试验阳性,发生率分别为81.0%(47/58)和89.7%(52/58),经治疗后均缓解或消失,未发生与操作相关的严重并发症.结论 胃镜直视下镍钛记忆合金支架置入术治疗胃内恶性梗阻,是简单、有效的方法之一,大部分并发症是可以预防和治疗的.     

胃镜直视下金属支架治疗58例胃内恶性梗阻

目的 探讨胃镜直视下置入镍钛记忆合金支架对胃内恶性梗阻的疗效和并发症发生的情况.方法 2006年1月至2008年10月对58例胃癌合并恶性不全性梗阻患者,在胃镜直视下置入镍钛记忆合金支架.结果 共置入27例贲门支架,5例胃体支架,26例胃窦幽门支架.胃镜直视下置入支架成功率100.0%(58/58),1个月后临床有效率93.1%(54/58).主要并发症为疼痛和粪隐血试验阳性,发生率分别为81.0%(47/58)和89.7%(52/58),经治疗后均缓解或消失,未发生与操作相关的严重并发症.结论 胃镜直视下镍钛记忆合金支架置入术治疗胃内恶性梗阻,是简单、有效的方法之一,大部分并发症是可以预防和治疗的.     

胃镜直视下金属支架治疗58例胃内恶性梗阻

目的 探讨胃镜直视下置入镍钛记忆合金支架对胃内恶性梗阻的疗效和并发症发生的情况.方法 2006年1月至2008年10月对58例胃癌合并恶性不全性梗阻患者,在胃镜直视下置入镍钛记忆合金支架.结果 共置入27例贲门支架,5例胃体支架,26例胃窦幽门支架.胃镜直视下置入支架成功率100.0%(58/58),1个月后临床有效率93.1%(54/58).主要并发症为疼痛和粪隐血试验阳性,发生率分别为81.0%(47/58)和89.7%(52/58),经治疗后均缓解或消失,未发生与操作相关的严重并发症.结论 胃镜直视下镍钛记忆合金支架置入术治疗胃内恶性梗阻,是简单、有效的方法之一,大部分并发症是可以预防和治疗的.     

胃镜直视下金属支架治疗58例胃内恶性梗阻

目的 探讨胃镜直视下置入镍钛记忆合金支架对胃内恶性梗阻的疗效和并发症发生的情况.方法 2006年1月至2008年10月对58例胃癌合并恶性不全性梗阻患者,在胃镜直视下置入镍钛记忆合金支架.结果 共置入27例贲门支架,5例胃体支架,26例胃窦幽门支架.胃镜直视下置入支架成功率100.0%(58/58),1个月后临床有效率93.1%(54/58).主要并发症为疼痛和粪隐血试验阳性,发生率分别为81.0%(47/58)和89.7%(52/58),经治疗后均缓解或消失,未发生与操作相关的严重并发症.结论 胃镜直视下镍钛记忆合金支架置入术治疗胃内恶性梗阻,是简单、有效的方法之一,大部分并发症是可以预防和治疗的.     

结肠金属支架在左半结肠癌合并梗阻中的临床应用

目的：探讨金属支架在左半结肠癌合并梗阻中的临床应用价值。方法：选取20例左半结肠癌合并梗阻患者,均行金属支架置入梗阻后一期切除吻合,探讨其临床疗效。结果：20例患者金属支架置入梗阻后2 d腹围减少至置入前的（86.2±3.0）%,差异具有统计学意义（P〈0.01）;腹部立位X线片示液气平减少,肠管扩张程度减轻,近端结肠最大横径减少至（4.32±0.6）cm,与置入前的（8.1±0.7）cm比较,差异具有统计学意义（P〈0.01）;患者腹痛、腹胀症状较术前均明显缓解。结论：结肠金属支架应用于左半结肠癌并梗阻患者行一期肠切除吻合,是安全、有效的治疗方法,值得推广。     

Transnasal endoscopic placement of nasoenteric feeding tubes: outcomes and limitations in non-critically ill patients.

Transnasal endoscopic placement of nasoenteric tubes (NETs) has been demonstrated to be useful in the critical care setting, with limited data on its role in non-critically ill patients. The authors collected data on consecutive patients from a non-critical care setting undergoing transnasal endoscopic NET placement. All NETs were endoscopically placed using a standard over-the-guidewire technique, and positions were confirmed with fluoroscopy. Patients were monitored until the removal of NETs or death. Twenty-two patients (median age = 62.5 years, 36.4% female) were referred for postpyloric feeding, with main indications of persistent gastrocutaneous fistula (n = 6), gastroparesis or gastric outlet obstruction (n = 5), duodenal stenosis (n = 6), acute pancreatitis (n = 4), and gastroesophageal reflux after surgery (n = 1). Postpyloric placement of NET was achieved in 19 of 22 (86.3%) patients, with 36.8% tube positions in the jejunum, 47.4% in the distal duodenum, and 15.8% in the second part of the duodenum. NET placement was least successful in cases with duodenal stenosis. NETs remained in situ for a median of 24 days (range, 2-94), with tube dislodgement (n = 3) and clogging (n = 5) as the main complications. NET feeding resulted in complete healing of gastrocutaneous fistulae in 5 of 6 patients and provision of total enteral nutrition in 3 of 4 cases of acute pancreatitis and 9 of 11 cases of gastroparesis or proximal duodenal obstruction. Transnasal endoscopy has a role in the placement of NET in non-critically ill patients requiring postpyloric feeding. However, there are some limitations, particularly in cases with altered duodenal anatomy.     

Gastrojejunostomy versus endoscopic stent placement as palliative treatment for a malignant constriction of the duodenum: the SUSTENT-study

Gastric-outlet obstruction often results from inoperable distal stomach, periampullary (pancreatic or cholangio-), or duodenal carcinoma. Gastrojejunostomy and stent placement are standard palliative treatments. An advantage of gastrojejunostomy is the long-term efficacy; a disadvantage is the prolonged postoperative recovery time. The advantage of stent placement is the rapid ability to consume a soft diet; a disadvantage is that around 20% of the patients require re-intervention because of recurrent symptoms. A randomised multicentre study was started in January 2006 in the Netherlands in which gastrojejunostomy is compared with stent placement in the palliative treatment of malignant gastroduodenal obstruction: 'Surgery versus stent for malignant gastroduodenal obstruction', the SUSTENT-study. The primary-outcome measurement is survival adjusted for the time patients are not able to consume (soft) food. Other outcome measurements are medical effects (complications, re-interventions), quality of life, cost and cost-effectiveness. This study aims to provide individualised recommendations for effective palliative treatment of patients with malignant gastroduodenal obstruction.     

Palliative treatment of esophageal cancer with dysphagia: more favourable outcome from single-dose internal brachytherapy than from the placement of a self-expanding stent; a multicenter randomised study

OBJECTIVE: To compare the results of single-dose internal irradiation (brachytherapy) and self-expanding metal stent placement in the palliation of oesophageal obstruction due to cancer of the oesophagus. DESIGN: Randomised trial. METHOD: In the period from December 1999-Jun 2002, 209 patients with dysphagia due to inoperable carcinoma of the oesophagus were randomised to placement of an Ultraflex stent (n = 108) or single-dose (12 Gy) brachytherapy (n = 101). Primary outcome was relief of dysphagia; secondary outcomes were complications, persistent or recurrent dysphagia, health-related quality of life, and costs. Patients were followed up by monthly home visits from a specialised nurse. RESULTS: Dysphagia improved more rapidly after stent placement than after brachytherapy, but long-term relief of dysphagia was better after brachytherapy. Stent placement resulted in more complications than did brachytherapy (36/108 (33%) versus 21/101 (21%); p = 0.02), due mainly to an increased incidence of late haemorrhage in the stent group (14 versus 5; p = 0.05). The groups did not differ with regard to the incidence of persistent or recurrent dysphagia or median survival (p > 0.20). In the long term, quality-of-life scores were higher in the brachytherapy group. Total medical costs were also similar for both treatments: Euro 8,215 for stent placement and Euro 8,135 for brachytherapy. CONCLUSION: Brachytherapy provided better long-term relief of dysphagia than did stent placement and also produced fewer complications. Brachytherapy is therefore recommended as the preferred treatment for the palliation of dysphagia due to oesophageal cancer.     

内镜下金属支架置入治疗幽门及十二指肠恶性梗阻临床分析

目的探讨内镜下金属支架置入治疗幽门及十二指肠恶性梗阻的临床价值。方法对2004.3～2011.9经内镜放置金属支架治疗幽门及十二指肠恶性梗阻24例临床资料回顾性分析。结果 24例共放置支架27枚,失败1例,成功23例,成功率（95.83%）。1例不成功因为支架置入器未能进入狭窄部位,22例患者临床症状缓解,临床有效率（91.67%）。4例患者置入2个支架,2例患者支架移位,2例患者肿瘤向上生长。并发症4例,2例移位,2例梗阻,发生率（16.67%）。结论内镜下金属支架置入是治疗幽门及十二指肠恶性梗阻的有效、安全、简单、可行的治疗方法。     

内镜下自膨式无覆膜结肠金属支架置入治疗左侧结肠恶性梗阻

目的 探讨经内镜自膨式无覆膜金属支架置入治疗左侧结肠癌性梗阻的临床价值.方法 根据梗阻情况进行不同术前肠道准备后,经内镜放置金属支架治疗左侧结肠癌性梗阻患者21例,术后进行常规处理并随访.结果 21例结肠癌性梗阻中,放置金属支架成功率为100％,术后1～2d肠梗阻症状均得到缓解或消除;支架术后均有少量的便血6例,无大出血、穿孔及支架移位等并发症发生;21例患者术后均能恢复经口进食,生存期4 ～ 22月,平均生存期为7月.结论 经内镜放置自膨式无覆膜金属支架治疗左侧结肠癌性梗阻,操作简单、经济有效、术后并发症少,有效缓解患者的梗阻症状,提高其生活质量.     

胃癌根治术中隧道式空肠置管术后早期肠内营养支持的应用研究

目的探讨胃癌根治术中隧道式空肠置管术后早期肠内营养支持的可行性、安全性和临床效果。方法将42例胃癌患者随机分为肠内营养组(EN组,24例)和肠外营养组(PN组,18例)。EN组采用隧道式空肠置管,术后早期进行肠内营养,并分别在营养支持前后各测1次体重、肝肾功能、血清蛋白、血红蛋白,临床观察胃肠道恢复情况。结果EN组血清蛋白、转铁蛋白水平在营养支持后明显升高,肛门恢复排气排便时间与PN组比较,差异有统计学意义(P<0.01)。结论胃癌术后早期肠内营养支持安全、可行,在改善机体营养状态方面有显著作用,并可促进胃肠道功能恢复,且费用较低。术中隧道式空肠置管简便易行,便于推广。     

Gastrojejunostomy versus endoscopic stent placement as palliative treatment of malignant stenosis of the duodenum: overview of advantages and disadvantages on the basis of a literature study

OBJECTIVE: To compare the results of stent placement and gastrojejunostomy in patients with malignant gastric outlet obstruction. Design. Systematic review. METHOD: PubMed was searched for relevant articles from January 1996 to January 2006 and further articles were obtained from their reference lists. Using results from these publications, average study scores for improvement of oral intake, complications, survival and costs were calculated. Results from randomized and comparative studies were pooled and odds ratios with 95% confidence intervals for improvement oforal intake and complications were calculated. RESULTS: A total of 44 publications were identified, including 2 randomized trials and 6 comparative studies. Information on study outcomes was not available in all publications. Long-term effectiveness was higher after gastrojejunostomy than after stent placement, with only 1% of patients needing a reintervention after gastrojejunostomy; more patients developed minor complications after gastrojejunostomy (33%) and the post-operative hospital stay was on average 13 days longer. After stent placement obstructive symptoms were relieved in 89% of patients and this effect was observed to occur more quickly after placement (within 0-2 days). More patients (approximately 20%) required a reintervention after stent placement due to stent migration or obstruction. CONCLUSION: Stent placement appeared to have favourable short-term results and gastrojejunostomy was associated with better long-term results. Well-performed clinical trials with an adequate number of patients were not found, which precluded more solid conclusions.     

The use of a self-expanding stent as palliation or before elective surgery in patients with obstructive colorectal carcinoma

OBJECTIVE: To evaluate the use of colorectal stents. DESIGN: Retrospective. METHOD: Data were collected on all patients treated at the Deventer Hospital, the Netherlands, between 1 April 1996 and 31 December 2003 in whom the placement of a self-expanding colorectal stent was attempted. Each patient's physician was contacted to inquire about the patient's status, including quality of life with the stent in situ. RESULTS: Stent placement was attempted in 57 patients as palliation (n = 45) or before elective surgery (n = 12). Of the 57 patients, 29 were men and 28 were women, and the mean age was 71 years (range: 46-94). All patients had colorectal carcinoma, except 1 patient with stenosis following ischaemic colitis. Passage of air and faeces occurred immediately after stent expansion in 55 of the 57 patients (96%). Perforation during stent placement occurred in 2 patients, who subsequently underwent colostomy. 4 additional patients required a colostomy due to stent migration within a few hours or days after placement (n = 3) or obstruction by tumor growth after 65 days (n = 1). Patients in the palliative group had an acceptable quality of life. Those who received a stent before elective surgery were able to undergo resection, did not require colostomy, and had no postoperative complications. One patient did not undergo surgery because of extensive metastases. CONCLUSION: A colorectal stent can be used in the palliative treatment of terminal patients with colorectal carcinoma before colostomy is considered. Experiences with stents before elective surgery were also positive.