内镜介入治疗胃肠道癌性梗阻.pdf

内镜介入治疗胃肠道癌性梗阻 徐美东 姚礼庆 钟芸诗 高卫东 周平红 何国杰 复旦大学附属中山医院普外科、内镜中心 复旦大学上海医学院外科学系 上海 200032 【摘要】 目的 探讨经内镜介入治疗胃肠道癌性梗阻的可行性与临床疗效。 方法 在X线辅助下经内镜介入治疗32例胃肠道癌性梗阻的病人，其梗阻的部位分别 为胃出口8例、十二指肠7例、直肠13例，乙状结肠4例。 结果 32例中30例放置支架成功，成功率为93.7％，术后1～3天梗阻症状均得到缓 解或消除，其中15例胃出口及十二指肠梗阻均为永久性姑息治疗，15例结直肠梗阻 中，12例为姑息治疗，3例经内镜治疗解除梗阻后行Ⅰ期肿瘤切除术。1例直肠癌术 后复发伴盆腔广泛转移者治疗失败，1例乙状结肠癌广泛转移者术中穿孔而急诊行 Hartmann术。随访期间，未发现支架移位，有1例放置十二指肠支架者，术后2月 肿瘤浸润支架远端导致梗阻复发，置入第二根支架后缓解。 结论 经内镜介入治疗胃肠道癌性梗阻是一种简单可行、经济有效、并发症少的方法， 可以显著降低病人的创伤和痛苦，提高病人的生活质量。 【关键词】内镜；介入治疗；胃肠道肿瘤；梗阻 Endoscopic interventional treatment of malignant gastrointestinal obstruction XU Mei-dong ,YAO Li-qing, ZHONG Yun-shi，Gao Wei-dong, He Guo-jie, Zhou Ping-hong. Department of General Surgery, Zhongshan Hospital; Department of Surgery, Shanghai Medical College, Fudan University ，Shanghai ，200032, China 【Abstract 】 Objective To evaluate the feasibility and clinical value of endoscopic interventional treatment of malignant gastrointestinal obstruction. Methods With the aid of fluoroscopy, 32 cases with malignant gastrointestinal 1 obstruction were treated with endoscopic metal stenting. Their obstructive sites consisted of gastric outlet(n=8), duodenum(n=7), rectum(n=13), sigmoid colon(n=4). Results Of 32 patients, 30 cases were successfully inserted metal stents (30/32, 93.7 ％), and showed relief of obstructive symptoms within 1~3 days. Permanent metal stent placement was performed in all 15 cases with malignant obstruction of gastric outlet or duodenum. For 15 cases of colorectal malignant obstruction, 12 were inserted metal stents for palliative treatment, 3 underwent subsequent elective surgical resection. One case with recurrent rectal carcinoma after resection was failure , one case with