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目的评价内镜下放置金属支架在治疗幽门及十二指肠恶性狭窄的临床疗效。资料与方法选择晚期胃窦癌16例、幽门管癌8例和十二指肠癌5例作为支架组,在内镜下放置金属支架。选择同期18例晚期胃窦癌、幽门管癌7例和3例十二指肠癌为手术组,行姑息性胃-空肠吻合手术。观察支架组支架置入成功率和幽门或十二指肠狭窄改善情况及两组患者生活质量状况、生存时间、副作用、平均住院时间和平均住院费用。结果支架组支架放置成功率为96.6%,幽门和十二指肠狭窄有明显改善,生活质量明显改善,生存时间延长,与手术组相比无统计学差异。但支架组平均住院时间为5天,平均住院费用为0.65万元,手术组平均住院时间为11天,平均住院费用约为1.51万元,副作用也明显少于手术组。结论内镜下放置金属支架不但能解决幽门和十二指肠恶性狭窄,提高患者的生活质量,延长患者生存时间,还能减少平均住院时间和医疗费用,是缓解幽门及十二指肠恶性狭窄的理想方法之一。
Objective To evaluate the clinical efficacy of endoscopic placement of metal stents in the treatment of malignant pyloric and duodenal strictures. Materials and Methods 16 cases of advanced gastric cancer, 8 cases of pyloric duct cancer and 5 cases of duodenal cancer as the stent group, metal stent placed endoscopic. Select the same period of 18 cases of advanced gastric cancer, pyloric duct cancer in 7 cases and 3 cases of duodenal cancer for the surgery group, the implementation of palliative gastrojejunostomy surgery. The success rate of stent placement and the improvement of pylorus or duodenum stenosis were observed. The quality of life, survival time, side effects, average length of stay, and hospitalization cost were compared between the two groups. Results The success rate of stent placement was 96.6%. Pylorus and duodenal stricture were significantly improved, the quality of life improved significantly, and the survival time was prolonged. There was no significant difference between the two groups. However, the average length of stay of the stent group was 5 days, the average hospitalization cost was 6,500 yuan, the average length of stay in the operation group was 11 days, and the average hospitalization cost was about 15,100 yuan. The side effects were also significantly less than those in the operation group. Conclusion Endoscopic placement of the metal stent not only solves the malignant stenosis of pylorus and duodenum, improves the quality of life of patients, prolongs the survival time of patients, but also reduces the average length of hospital stay and medical expenses, relieves pyloric and duodenal malignant stenosis One of the ideal ways.