Wai C T, Ho K Y, Yeoh K G, Lim S G
Department of Medicine, National University Hospital, Singapore.
Surg Laparosc Endosc Percutan Tech. 2001 Jun;11(3):161-4.
Gastric carcinoma is among the most common cancers worldwide. Surgery remains the mainstay of potentially curative treatments. Unfortunately, most patients have an advanced form of the disease. We evaluated our experience in palliating malignant gastric outlet obstruction caused by gastric cancer with expandable metal stents (Wallstent Enteral; Boston Scientific, Singapore). Six patients with a median age of 68 years (range, 45-88) underwent the procedure. Three had metastatic gastric cancer; two recurrent gastric cancer; and one locally advanced gastric cancer with poor comorbid status. After the procedure, five of the six patients were able to resume an oral feeding within 24 hours. One patient with gastric dysmotility caused by linitus plastica required nasogastric tube feeding. Three patients died during a median follow-up period of 4 weeks (range, 2-8). The other three patients were still well at a median follow-up period of 10 weeks (range, 5-12). There was no procedure-related mortality or morbidity, nor was there any stent migration or blockage in any of these patients. In conclusion, palliation of malignant gastric outlet strictures caused by gastric cancer with expandable metal stents is an effective and safe alternative to surgery, particularly in patients with postgastrectomy anastomotic recurrence and in those who are poor candidates for surgery. Patients who are not expected to survive beyond 1 month and those with linitus plastica and associated gastric dysmotility may not be appropriate candidates for such a procedure.
胃癌是全球最常见的癌症之一。手术仍然是潜在治愈性治疗的主要手段。不幸的是，大多数患者的病情已处于晚期。我们评估了使用可扩张金属支架（Wallstent Enteral；波士顿科学公司，新加坡）缓解胃癌所致恶性胃出口梗阻的经验。6例患者接受了该手术，中位年龄为68岁（范围45 - 88岁）。其中3例为转移性胃癌；2例为复发性胃癌；1例为局部晚期胃癌且合并症严重。术后，6例患者中有5例在24小时内能够恢复经口进食。1例因皮革胃导致胃动力障碍的患者需要鼻饲喂养。3例患者在中位随访期4周（范围2 - 8周）内死亡。其他3例患者在中位随访期10周（范围5 - 12周）时仍状况良好。这些患者均未发生与手术相关的死亡或并发症，也没有出现支架移位或堵塞的情况。总之，使用可扩张金属支架缓解胃癌所致恶性胃出口狭窄是一种有效且安全的手术替代方法，尤其适用于胃切除术后吻合口复发的患者以及手术耐受性差的患者。预计生存期不足1个月的患者以及患有皮革胃和相关胃动力障碍的患者可能不适合进行此类手术。
