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1、内镜介入治疗胃肠道癌性梗阻徐美东姚礼庆钟芸诗高卫东周平红何国杰复旦大学附属中山医院普外科、内镜中心复旦大学上海医学院外科学系上海200032【摘要】目的探讨经内镜介入治疗胃肠道癌性梗阻的可行性与临床疗效。方法在X线辅助下经内镜介入治疗32例胃肠道癌性梗阻的病人，其梗阻的部位分别为胃出口8例、十二指肠7例、直肠13例，乙状结肠4例。结果32例中30例放置支架成功，成功率为93.7％，术后1～3天梗阻症状均得到缓解或消除，其中15例胃出口及十二指肠梗阻均为永久性姑息治疗，15例结直肠梗阻中，12例为姑息治疗，3例经内镜治疗解除梗阻后行Ⅰ期肿瘤切除术。1例直肠癌术后复发伴盆腔广泛转移者治疗失败，1
2、例乙状结肠癌广泛转移者术中穿孔而急诊行Hartmann术。随访期间，未发现支架移位，有1例放置十二指肠支架者，术后2月肿瘤浸润支架远端导致梗阻复发，置入第二根支架后缓解。结论经内镜介入治疗胃肠道癌性梗阻是一种简单可行、经济有效、并发症少的方法，可以显著降低病人的创伤和痛苦，提高病人的生活质量。【关键词】内镜；介入治疗；胃肠道肿瘤；梗阻EndoscopicinterventionaltreatmentofmalignantgastrointestinalobstructionXUMei-dong,YAOLi-qing,ZHONGYun-shi，GaoWei-dong,HeGuo-jie,Zho
3、uPing-hong.DepartmentofGeneralSurgery,ZhongshanHospital;DepartmentofSurgery,ShanghaiMedicalCollege,FudanUniversity，Shanghai，200032,China【Abstract】ObjectiveToevaluatethefeasibilityandclinicalvalueofendoscopicinterventionaltreatmentofmalignantgastrointestinalobstruction.MethodsWiththeaidoffluoroscopy
4、,32caseswithmalignantgastrointestinal1obstructionweretreatedwithendoscopicmetalstenting.Theirobstructivesitesconsistedofgastricoutlet(n=8),duodenum(n=7),rectum(n=13),sigmoidcolon(n=4).ResultsOf32patients,30casesweresuccessfullyinsertedmetalstents(30/32,93.7％),andshowedreliefofobstructivesymptomswit
5、hin1~3days.Permanentmetalstentplacementwasperformedinall15caseswithmalignantobstructionofgastricoutletorduodenum.For15casesofcolorectalmalignantobstruction,12wereinsertedmetalstentsforpalliativetreatment,3underwentsubsequentelectivesurgicalresection.Onecasewithrecurrentrectalcarcinomaafterresection
6、wasfailure,onecasewithwidespreadmetastaticsigmoidcoloncarcinomaoccurredcolonperforationandreceivedimmediateHartmannoperation.Duringthefollow-upperiod,stentmigrationwasnotdetected.Tumorovergrowthwasfoundinoneduodenalobstructionpatient2monthsafterstentinsertion,andasecondstentwasplacedtosolvetheprobl
7、em.ConclusionsEndoscopicinterventionaltreatmentofmalignantgastrointestinalobstructionisafeasible,safe,effectiveandwelltoleratedmethod.Itcanreducethepatients’traumaandpain,andincreasethepatients’livingqualit
