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首页> 外文期刊>Surgical Endoscopy >Role of self-expandable metal stents in the palliation of malignant duodenal obstruction.
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Role of self-expandable metal stents in the palliation of malignant duodenal obstruction.

机译：自膨胀金属支架在恶性十二指肠梗阻缓解中的作用。

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BACKGROUND: Palliative surgical intervention for malignant duodenal obstruction is often associated with a significant morbidity. Endoscopic enteral stenting offers a suitable alternative, that is safe, effective, and less invasive. This study reports our experience with the use of self-expanding metal stents in the palliation of malignant gastric duodenal obstruction. METHODS: A retrospective review of all patients who underwent duodenal stenting from November 1998 to February 2001 was performed. All the patients had symptomatic gastric outlet and duodenal obstruction with nausea, vomiting, and decreased oral intake. All of them underwent enteral stenting with self-expandable metal Wallstents 20 or 22 mm in diameter and 6 or 9 cm long. RESULTS: For this study, 33 patients (19 men and 14 women) with a mean age of 62 years (range, 37-81 years) were identified, 32 of whom had successful duodenal stent placement (6 were performed as outpatient surgery). The malignancies were pancreatic 18 (54%), gastric 4(12%), duodenal 3 (9%), metastatic 6 (18%), and cholangiocarcinoma 2 (6%) disorders. The site of obstruction was pyloric (n = 5; 15%), pyloroduodenal (n = 3; 9%), duodenal bulb (n = 11; 33%), second portion of duodenum (n = 9; 27%), second and third portion of duodenum (n = 3; 9%), C-loop (n = 1; 3%), and anastomotic (n = 1; 3%). A total of 29 patients (91%) had good clinical outcomes, with relief of obstructive symptoms, Two of three patients with no symptomatic relief underwent gastrojejunostomy. One patient refused further treatment. No immediate stent-related complications were noted. During the follow-up period, 20 patients died (none as a result stent-related causes) due to progression of cancer. Median survival was 102 days. Four patients had recurrent obstruction (2 tumor ingrowths, 1 overgrowth, and 1 distally migrated stent) at a mean interval of 82 days. All four had successful restenting without complications. CONCLUSION: Self-expandable metal stents placed endoscopically provide a safe, less invasive palliative treatment option with good clinical outcome in the management of malignant gastric outlet-duodenal obstruction.
机译：背景：姑息性外科手术治疗恶性十二指肠梗阻通常与明显的发病率相关。内窥镜肠内支架术是安全，有效且侵入性较小的合适替代方法。这项研究报告了我们使用自膨胀金属支架缓解恶性胃十二指肠梗阻的经验。方法：对1998年11月至2001年2月行十二指肠支架置入术的所有患者进行回顾性回顾。所有患者均出现症状性胃出口和十二指肠阻塞，伴有恶心，呕吐和口服摄入减少。他们都用直径20或22毫米，长6或9厘米的自膨胀金属Wallstents进行肠内支架置入术。结果：本研究确定了33例患者（男19例，女14例），平均年龄62岁（范围37-81岁），其中32例成功放置了十二指肠支架（6例作为门诊手术）。恶性肿瘤为胰腺18（54％），胃4（12％），十二指肠3（9％），转移性6（18％）和胆管癌2（6％）疾病。阻塞部位为幽门（n = 5; 15％），幽门十二指肠（n = 3; 9％），十二指肠球（n = 11; 33％），十二指肠第二部分（n = 9; 27％），第二十二指肠的第三部分（n = 3; 9％），C环（n = 1; 3％）和吻合口（n = 1; 3％）。共有29例患者（91％）取得了良好的临床效果，并缓解了阻塞性症状。三例中无症状缓解的患者中有2例接受了胃空肠吻合术。一名患者拒绝进一步治疗。没有发现立即发生的支架相关并发症。在随访期间，有20名患者因癌症进展而死亡（无因支架相关的原因）。中位生存期为102天。 4例患者平均复发间隔为82天（2个肿瘤向内生长，1个过度生长和1个向远端迁移的支架）。四个人都成功地成功康复，没有并发症。结论：内窥镜放置的自膨式金属支架可提供安全，侵入性较小的姑息治疗方案，在恶性胃十二指肠梗阻的治疗中具有良好的临床效果。

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