摘要
目的评价X线引导下经鼻插入鼻-肠梗阻导管治疗不能手术的恶性肠梗阻的技术可行性和疗效。方法 X线引导下应用传统法(76例)或导丝导管交换法(135例)经鼻插入鼻-肠梗阻导管引流治疗不能手术的恶性肠梗阻患者211例(KPS 20～60分,中位40分),统计技术成功率、临床有效率、治愈率和不良反应及并发症发生情况;分析梗阻部位、梗阻原因与疗效关系。鼻-肠梗阻导管采用库利艾特公司生产的四腔双球囊导管,管径为16 F/18 F。结果总技术成功率100%,传统法和导丝导管交换法一次性成功率分别为85.5%(65/76)和100%(135/135),两种方法比较差异有统计学意义(P<0.05)。术后24 h,高位小肠、低位小肠和结直肠梗阻的临床有效率分别为95.8%(46/48),92.9%(117/126)和83.8%(31/37)。随访4～245 d(平均138 d),总临床治愈率27.5%(58/211),肿瘤性与粘连性梗阻的临床治愈率分别为22.7%(42/194)和94.1%(16/17),两者间差异有统计学意义(P<0.05)。小肠和结直肠恶性梗阻的临床治愈率分别为12.7%(20/157)和59.5%(22/37),两者间差异有统计学意义(P<0.05)。不良反应及并发症包括咽部不适或疼痛99.1%(199/211)、导管阻塞23.2%(49/211)、导管脱落1.9%(4/211)、导管断裂0.1%(2/211)、肠出血0.1%(2/211)、肠穿孔0.1%(1/211),总的严重并发症发生率为4.7%,涉及咽部剧痛、肠出血、肠穿孔、导管断裂;无与死亡相关的并发症。结论 X引导下经鼻-肠梗阻导管插入引流治疗不能手术的恶性肠梗阻安全、有效,尤其适用于术后粘连性小肠梗阻以及结肠直肠恶性狭窄支架置入前的评估和治疗。
Objective To assess the technical feasibility and effectiveness of fluoroscopically-guided transnasal insertion of ileus tube for intestinal decompression in the treatment of inoperable malignant bowel obstruction.Methods A total of 211 patients with inoperable malignant bowel obstruction were enrolled in this study.The median KPS scale was 40（ranged from 20 to 60）.Under fluoroscopic guidance,transnasal insertion of ileus tube by using conventional technique or guidewire-catheter exchange technique was performed in all patients.The technical success rate,the clinical effective rate,the curative rate and adverse reactions as well as complications were documented.The correlation among the obstructive sites,obstruction causes and therapeutic effectiveness was analyzed.The ileus tube used in this study was a four-cavity and double-balloon catheter with a diameter of 16 F/18 F,which is produced by Cliny Company.Results Transnasal drainage tube was successfully inserted into the proximal jejunum in all 211 patients with malignant bowel obstruction,and the total technical success rate was 100%.The initial technical success rate of the traditional technique and the catheter-guidewire exchange method was 85.5%（65/76） and 100%（135/135） respectively,the difference between the two was significant（P 0.05）.After 24 hours,the clinical remission rate in the patients with high-level intestinal obstruction,lower-level intestinal obstruction and colorectal obstruction was 95.8%（46/48）,92.9%（117/126） and 83.8%（31/37）,respectively.A follow-up of 4-245 days（mean 138 days） was conducted,and the total clinical cure rate was 27.5%（58/211）.The clinical cure rate in small intestine obstruction and colorectal obstruction caused by primary tumor or recurrence was 12.7%（20/157） and 59.5%（22/37）,respectively（P 0.05）.The adverse reactions and complications included uncomfortable pharynx feeling or pain（99.1%,199/211）,the tube obstruction（23.2%,49/211） the tube displacement（1.9%,4/211）
出处
《介入放射学杂志》
CSCD
北大核心
2011年第12期979-983,共5页
Journal of Interventional Radiology
关键词
恶性肿瘤
肠梗阻
鼻-肠管
引流
malignancy
bowel obstruction
transnasal intestinal tube
drainage
