自制镍钛记忆合金支架在幽门十二指肠恶性梗阻中的应用

目的:探讨幽门十二指肠恶性梗阻时镍钛记忆合金支架置入的操作技术及其临床疗效。方法:本组30例患者,胃窦癌5例,胃窦癌术后吻合口狭窄5例,贲门癌术后复发伴幽门梗阻6例,结肠癌晚期伴胆管、十二指肠恶性梗阻2例,胰头癌浸润十二指肠7例,十二指肠癌5例。所有病人均行胃镜和上消化道碘剂造影以证实梗阻部位及其程度,选择合适的支架。经胃镜插入导丝,在X线监视下将导丝送至梗阻远端,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,其中4例支架经内镜活检孔送入。术后观察病人腹胀、呕吐等临床症状的改善情况。结果:本组支架一次置入成功29例,成功率96.67%。其中有7例为双支架置入(同时置胆总管支架)。支架置入后1周,患者腹胀消失率为21/30(70%),呕吐消失率为23/30(76.67%)。未发生与操作相关的近期并发症。结论:采用自制镍钛记忆合金幽门支架治疗幽门恶性狭窄,能明显改善患者生存质量,是一种安全有效的治疗方法。

Clinical Studies of Self-expandable Nitinol Stent for the Relief of Malignant Pylorus or Duodenal Obstruction

Objective: To study the technique of placement of Nitinol stent for the relief of malignant pylorus or duodenal obstruction,and to assess its clinical effectiveness. Methods: In this group the strictures were caused by gastric carcinoma at the antrum (n=5), anastomosis site of previous gastrojejunostomy(n=5), gastric carcinoma at the cardia (n=6), colon cancer (n=2),pancreatic cancer(n=7) and duodenal cancer (n=5). Under fluoroscopic guidance the Nitinol stent was inserted into pylorus or duodenal obstruction sites from oral cavity in all cases. Complications and clinical status were investigated during the study period. Results Successful stent placement was achieved in 29 cases. Seven patients had undergone double stent placement (pylorus stent and bile duct stent).The rate of abdominal distention and vomiting improvement were 70% and 76.67% respectively. There was no procedure-related complications. Conclusion: Nitinol alloy network stent is a safe and efficacious method for palliating malignant pylorus or duodenal obstruction,and improves patient's living quality.