经口放置金属支架治疗胃、十二指肠及空肠恶性狭窄67例

目的 探讨经口放置胃肠道内支架的方法，评价金属支架在治疗胃、十二指肠及空肠恶性狭窄中的作用。方法 胃、十二指肠及近端空肠恶性狭窄病例67例。在X线监视下通过递送导管或胃镜经口送入超滑导丝并使之过胃、十二指肠狭窄或阻塞段；经交换导管替换软头特硬导丝后由硬导丝引入附镍钛合金支架之套管式推送器将支架送入狭窄段释放。对完全阻塞使用胃镜仍不能将导丝送入者则经胃镜用微波或热极烧灼形成小通道后再送入导丝引入支架（5例）。结果 67例中有64例经97例次操作，成功地放置了83个支架。支架置于胃体及幽门部18个，胃肠吻合口17个，十二指肠降段和水平段44个，近端空肠4个。另3例经5次操作放置支架未成功。支架置入病例临床症状均获缓解（59例）或明显改善（5例）。术后1个月复查支架通畅率97．5％，有4例共5个支架分别于支架置入后16－61d移位脱落，其中1个经口取出、3个自行经肛门排出、1个滞留于回盲部但均未出现并发症。结论 经口放置金属支架能有效缓解胃、十二指肠及空肠梗阻，为提高晚期肿瘤患者的生活质量、延长其生存时间，提供了姑息性治疗的方法。

Treatment of malignantstenosis of stomach

Objective To explore methods of remote implanting gastointesinal inner stent in digestive tract and evaluate the value of metal inner stent implantation in the treatment of malignant gastro duodenal jejunal stenosis. Methods There were 67 cases with malignant gastro duodenal and proximal jejunal stenosis, age ranged from 20 to 86 years. Under X ray monitoring super slip guide wire was introduced in by conveying catheter or gastroscope, passing through gastro duodenal stenosis or obstruction. For those of complete obstruction or failure for the guide wire to pass, we used microwave or heat node to build fine path first, and then we inserted guidewire to pass through with stent implanted. Results 64 cases of the whole group were operated for 95 times, 83 metal stents were implanted successfully. Among them, 18 times in gastric corpus and pyloric part,17 times in gastro intestinal anastomosis.44 times in duodenal descending and horizontal segment,4 times in proximal jejunum, 59 cases had clinical symptomatic remission ,and 5 cases had much improvement in general condition. One month postoperative examination showed stent passing rate as 97.5%. Five stents in 4 cases revealed migration from 16 to 61 days after implantation. One stent was taken out through oral cavity,other three stents through anus and another one stayed at ileocecal region without any complication.Conclusion Peroral implantation of metal stents alleviated malignant gastro duodenal and jejunal stenosis providing palliative treatment, raising quality of life and prolonging survival time in advanced cancer patients.