摘要
目的探讨经内镜放置金属支架联合局部种植化疗药物治疗胃出口恶性梗阻的有效性和临床价值。方法将胃窦部或幽门癌并有梗阻患者42例，随机分成三组，即单纯幽门支架置入组（支架组）12例：经内镜直视下放置幽门支架；幽门支架置入联合局部注射化疗药物组（联合组）12例：先放置幽门支架，患者休息片刻后再次插镜，根据肿瘤大小和范围，注射5-氟尿嘧啶500mg和丝裂霉素4mg，深度0．5～1．0cm；另选择同期拒绝任何支架置入及放化疗的患者作为对照组18例：只予静脉或口服药物对症支持治疗。分别与第4、8、12周分别复查胃镜及疗效判定。结果本组24例支架放置皆1次成功，术后24～48h摄片示支架膨胀约90％，2例术后出血，予保守治疗而愈。术后随访3个月，无支架移位发生。支架组、联合组、对照组平均通畅期分别为51．9天、73．2天、23．1天；支架组与对照组比较（t=117．1，P〈0．001）、联合组与支架组比较（t=48．9，P〈0．001），通畅期均明显延长，具有显著性差异。结论单纯置入支架组与支架置入联合局部注射化疗药物组疗效均明显优于对照组，而联合组与支架组比较，联合组通畅期明显长于单纯支架组，说明支架置入联合局部注射化疗药物缓解患者梗阻的时间更长，临床价值更高。
Objective To evaluate the value of endoscopic placement of metal stent implantation combined with local chemotherapy for malignant gastric outlet obstructions. Methods 42 patients with antrum or pylorus cancer were randomly divided into three groups： pyloric stent alone group （stent group, n = 12） ： Endoscopic stent placement by special pylorus; pyloric stent implantation combined with local chemotherapy group （combination group, n = 12） ： first, pyloric stent placement, the patient again after a short break inserted mirror, according to tumor size and extent of injection of 5 - fluorouracil 500mg and mitomycin 4rag, depth of 0.5 - 1.0cm ; other options over the same period the patients refused any treatment as control group （n = 18） ： only for intravenous or oral comprehensive support treatment. 4,8,12 weeks respectively, the endoscopy and efficacy were determined. Results 24 cases are a successful stent placement, after 24- 48h ray showed about 90% of stent expansion, 2 cases of postoperative bleeding, to the more conservative treatment. Follow -up 3mo, no stent migration occurred. Stent group, combination group and the control group, the average patency period was 51.9d, 73.2d, 23.1 d ; Stent group compared with control group （ t = 117.1, P 〈0.001 ） , combination group with the stent group （ t = 48.9, P 〈 0. 001 ） were significantly prolonged patency period with a significant difference. Conclusion The stent alone and stent implantation combined with local chemotherapy group was significantly better than the control group. Patency period was significantly longer in combination group compared with the stent group, indicating that local injection of stent implantation in patients with obstruction of chemotherapy drugs to extend longer, higher clinical value.
出处
《医学研究杂志》
2011年第7期74-77,共4页
Journal of Medical Research
基金
浙江省医药卫生科学研究基金计划(B类)(2007B176)
关键词
金属支架置入
胃出口恶性梗阻
局部注射
化疗药物
Metal stent
Malignant gastric outlet obstruction
Local injection
Chemotherapy drugs
