【摘要】 目的评价Y型自膨式全覆膜金属支架治疗毕Ⅱ式术后胃空肠吻合口良性狭窄的安全性和疗效。方法回顾分析郑州大学第一附属医院2008年1月至2014年6月收治的8例(胃癌2例,胃十二指肠溃疡6例)毕Ⅱ术式后出现并证实为胃空肠吻合口良性狭窄患者临床及影像学资料。根据残胃-空肠吻合口狭窄的特殊解剖结构病变特点,自行设计Y型一体化自膨式全覆膜金属支架。X线监视下对8例毕Ⅱ术式后胃肠吻合口良性狭窄患者置入8枚Y型一体化自膨式全覆膜金属支架。并于支架置入后1个月、3个月行上消化道造影检查,观察支架通畅情况。3个月后X线监视下成功取出上述支架并随访4~18个月,观察患者进食通畅情况,于4~6个月时行上消化道造影,了解胃肠吻合口通畅情况。结果 8例患者支架均一次性成功置入,置入后患者腹胀、恶心、呕吐症状消失;术后3个月所有患者支架均成功取出,无出血、吻合口瘘等并发症发生。术后所有患者均获得完整随访,其中1例胃十二指肠溃疡患者于支架置入术后5个月死于蛛网膜下腔出血;余7例患者4~6个月复查上消化道造影均未见吻合口再次狭窄,患者生活质量明显提高。结论 Y型自膨式全覆膜金属支架治疗毕Ⅱ式术后胃肠吻合口狭窄是安全和可行的,初步疗效令人满意,但尚需大量样本随机对照研究进一步验证。更多还原

【Abstract】 Objective To evaluate the feasibility and efficacy of a novel covered Y-shape expandable metal stent in managing benign anastomotic stenosis of billroth Ⅱ operation. Methods The clinical data and images of 8 patients( gastric cancer in 2 and gastroduodenal ulcer in 6) diagnosed as benign anastomotic stricture after billrothⅡ operation from January 2008 to June 2014 were retrospectively analyzed.According to the anatomic features of anastomosis of gastric remnant and jejunum,a kind of novel coated Yshape self-expand metal stents was customized and then deployed in 8 cases under fluoroscopy. All patients underwent upper gastroenterography at post-procedural 1 month and 3 months to investigate the patency of stent. All stents got removed at 3 months after implantation if possible. The intakes of patients after stent being removed were evaluated and all patients were followed up for 4 to 18 months. Eight cases underwent upper gastroenterography at the follow-up of 4 to 6 months to investigate the anastomotic patency. Results All stents were successfully performed one-step and palliated abdominal distention,nausea and vomit of all patients. All stents were retrieved at post-procedural 3 months successfully and no complications such as bleeding,anastomotic leakage and so forth occurred. All patients were followed up for 4 to 18 months by upper gastroenterography. Only 1 patient with digestive tract ulcer died of subarachnoid hemorrhage 5 months after stent implantation. The upper gastroenterography of the other 7 cases,which achieved higher quality of life,indicated anastomotic patency. Conclusions The novel covered Y-shape expandable metal stent is a feasible and safe method of good short-term efficacy to manage the benign anastomotic stenosis of billrothⅡ operation.Additional randomized controlled studies of large sample are needed to verify the effectiveness of the stent.更多还原