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 总结1999年3月至2008年1月间复旦大学附属中山医院内镜中心采用内镜金属支架治疗胃出口梗阻56例患者的临床资料.结果 56例患者中男33例、女23例.年龄(65±14)岁;晚期胃窦癌17例,胃癌术后复发15例(其中毕Ⅰ式吻合8例),十二指肠癌4例,壶腹周围癌7例,转移性肿瘤13例.支架置入成功率98.2%(55/56).49例患者(87.5%)在支架置入1～3(2±1)d后开始进流质饮食,进食半流质的时间为4～9(6±2)d;42例(76.4%)患者在支架置入10～16(13±3)d后开始进普通饮食.并发症发生率包括疼痛14.5%、支架移位1.8%和出血25.5%,无穿孔.截至2008年1月20日,53例(96.4%)接受了随访,生存期14～332(139±15)d,中位生存期135 d.支架通畅率94.3%(50/53),有3例患者分别在术后143 d、158 d和190 d出现了再狭窄,通过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、安全、有效的方法.

Endoscopic serf-expanded metal stent for gastric outlet obstruction:a ten-year experience

Objective To evaluate the efficacy of endoscopic self-expanded metal stent for the treatment of gastric outlet obstruction.Methods Fifty-six cases of gastric outlet obstruction, collected from March 1999 to January 2008, were treated by endoscopic self-expanded metal stents. The success rate, complication rate and survival were evaluated. Results Among the 56 cases, the male to female ratio was 33 to 23, and the average age was [65±14(24-86)] years. Seventeen cases were gastric cancer, 4 duodenal carcinoma, 7 peri-ampulla carcinoma, 13 metastasis cancer and 15 presented recurrence after operations. The success rate of stent implantation was 98.2% (55/56). Forty-nine cases(87.5%) could eat liquid food 1-3 days after operations and eat semifluid food 4-9 days later. Forty-two cases (76.4%)could eat normal food after 10-16 days. The main complications included 14.5% of eases with pain, 1.8% with stent shift, 25.5% with bleeding and no one with perforation. Until January 20, 2008, 53 cases (96.4%) had been followed up. The mean survival time was [139±15(14-332)] days, and the median survival time was 135 days. The re-stenosis rate was 5.7%, including 3 cases, happened in 143, 158 and 190 days after the operations respectively, and was succesfully treated by second stent implantation. Conclusion Endoscopic implantation of self-expanded metal stent is a micro-invasive, safe, effective method for the treatment of gastric outlet obstruction.