摘要
目的介绍一种挂线自膨式金属支架内镜下置入处理胃大部切除术后输出梗阻的方法并探讨其应用效果。方法回顾华中科技大学同济医学院附属协和医院2018年12月至2021年8月4例胃肿瘤手术后输出梗阻病人行内镜下挂线支架治疗的临床过程并分析预后效果。结果4例出现输出梗阻症状的胃大部切除术后病人中,1例为吻合口狭窄,1例内镜下见输出袢扭转致吻合口处肠腔变窄,1例为吻合口位于小弯侧近贲门造成输出袢明显成角,1例为距吻合口处约3 cm处肠腔狭窄不通畅,均存在结构性异常。4例采取内镜下挂线支架治疗,支架置入4例均成功完成,支架置入后梗阻症状立即改善,造影示造影剂排空通畅。3例吻合口处异常经支架置入处理后梗阻症状未复发,1例输出肠袢梗阻经3次支架处理,拔除支架后梗阻症状再发,经再次手术处理解决。4例病人住院及随访期间未出现支架相关不良事件。结论对于BillrothⅡ式胃大部切除术后吻合口及输出袢狭窄、成角、轻度扭转等原因造成的梗阻,采用内镜下挂线自膨式金属支架置入处理,可以立即解除梗阻症状,部分维持一定时间后取出支架可完全解除梗阻。挂线支架作为传统保守治疗方法的替代或补充,可显著减少消化液丢失,尽快恢复肠内营养,减少不必要的非计划二次手术。
Objective To introduce an endoscopically placed hanging-type self-expandable metallic stent for output obstruction after subtotal gastrectomy and discuss its application efficacy.Methods From December 2018 to August 2021,clinical data were retrospectively reviewed for 4 patients with output obstruction after gastric tumor surgery undergoing endoscopic stenting.Results All of them developed output obstruction after subtotal gastrectomy.Endoscopic hanging-type stent was successfully implanted.Obstruction symptoms improved immediately after stenting.Three cases of anastomotic abnormalities had no recurrence and one case of efferent intestinal loop obstruction were stented thrice.After stent removal,obstruction symptoms recurred and resolved by secondary surgery.No stent-related adverse events were observed during hospitalization and follow-ups.Conclusion For obstruction caused by stenosis,angulation and mild torsion of anastomotic stoma or efferent loop after BillrothⅡsubtotal gastrectomy,self-expandable metallic stenting under endoscope may immediately relieve obstruction symptoms.And obstruction symptoms will not recur in some cases after stent removal.As an alternative or supplement to traditional conservative measures,hanging-type stent can significantly reduce digestive fluid loss,restore enteral nutrition promptly and avoid unnecessary unplanned secondary surgery.
作者
薛一凡
刘科
李航
曹英豪
陶凯雄
王继亮
吴轲
蔡开琳
Xue Yifan;Liu Ke;Li Hang;Cao Yinghao;Tao Kaixiong;Wang Jiliang;Wu Ke;Cai Kailin(Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science&Technology,Hubei Wuhan 430022,China)
出处
《腹部外科》
2023年第4期295-300,共6页
Journal of Abdominal Surgery
基金
国家自然科学基金(82170678)
湖北省国家重点研发计划项目(2021BAA044)。
