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目的 探讨经口放置胃肠道内支架的方法 ,评价金属支架在治疗胃、十二指肠及空肠恶性狭窄中的作用。方法 胃、十二指肠及近端空肠恶性狭窄病例 6 7例。在X线监视下通过递送导管或胃镜经口送入超滑导丝并使之过胃、十二指肠狭窄或阻塞段 ;经交换导管替换软头特硬导丝后由硬导丝引入附镍钛合金支架之套管式推送器将支架送入狭窄段释放。对完全阻塞使用胃镜仍不能将导丝送入者则经胃镜用微波或热极烧灼形成小通道后再送入导丝引入支架 (5例 )。结果 6 7例中有 6 4例经 97例次操作 ,成功地放置了 83个支架。支架置于胃体及幽门部 18个 ,胃肠吻合口 17个 ,十二指肠降段和水平段 44个 ,近端空肠 4个。另 3例经 5次操作放置支架未成功。支架置入病例临床症状均获缓解 (5 9例 )或明显改善 (5例 )。术后 1个月复查支架通畅率 97.5 % ,有 4例共 5个支架分别于支架置入后 16～6 1d移位脱落 ,其中 1个经口取出、3个自行经肛门排出、1个滞留于回盲部但均未出现并发症。结论 经口放置金属支架能有效缓解胃、十二指肠及空肠梗阻 ,为提高晚期肿瘤患者的生活质量、延长其生存时间 ,提供了姑息性治疗的方法
Objective To investigate the method of orally placing the stent in the gastrointestinal tract to evaluate the role of the metal stent in the treatment of malignant stenosis of the stomach, duodenum and jejunum. Methods Gastric, duodenal and proximal jejunal malignant stenosis cases 67 cases. Under the X-ray monitoring through the delivery catheter or gastroscope orally into the ultra-smooth guide wire and make it over the stomach, duodenal stenosis or obstruction; replaced by exchanging catheter soft tip special hard wire guide by hard wire NiTi stent stent push the stent into the narrow section of the release. Complete obstruction of the use of gastroscope still can not be sent to the guide wire by gastroscope with microwave or hot electrode cautery to form a small channel and then into the guide wire into the stent (5 cases). Results Sixty-four of 67 cases were operated in 97 procedures and 83 stents were successfully placed. Stents placed in the corpus and pylorus 18, gastrointestinal anastomosis 17, descending segment of the duodenum and the level of 44, 4 proximal jejunum. The other 3 cases after 5 operations placed stent unsuccessful. The clinical symptoms of stenting were relieved (59 cases) or significantly improved (5 cases). At 1 month after operation, the patency rate of the stent was 97.5%. Four of the four stents were displaced by the stent at 16 to 61 days after stent implantation. One of them was removed by mouth, three were excreted by the anus, and one was retained In the ileocecal department but no complications. Conclusion orally placed metal stent can effectively alleviate the stomach, duodenum and jejunum obstruction, in order to improve the quality of life of patients with advanced cancer and prolong their survival time, providing a palliative treatment