Mittal A, Windsor J, Woodfield J, Casey P, Lane M
Hepatobiliary-Pancreatic/Upper Gastrointestinal Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand.
Br J Surg. 2004 Feb;91(2):205-9. doi: 10.1002/bjs.4396.
The traditional management of pyloroduodenal obstruction is open gastrojejunostomy (OGJ). More recently laparoscopic gastrojejunostomy (LGJ) and endoscopic stenting (ES) have been introduced. The aim of this study was to evaluate the three approaches to the palliation of malignant pyloroduodenal obstruction.
All patients who underwent surgery (open and laparoscopic) for malignant pyloroduodenal obstruction at Auckland City Hospital between 1989 and 2002 inclusive were identified from International Classification of Diseases (ICD) 10 codes and from the Otago Surgical Audit Database. Patients who had an endoscopic stent were identified from the Endoscribe database. A review of medical records was conducted and data recorded in a structured pro forma. There were 181 patients with malignant pyloroduodenal obstruction of whom 56 patients had OGJ, 14 had LGJ and 16 had ES. Patients in the LGJ and ES groups were matched with those who underwent OGJ with respect to American Society of Anesthesiologists (ASA) grade (I-V), age (within 10 years) and level of obstruction (pylorus, first part of duodenum D1, D2, D3 and D4). The primary outcomes compared between the groups were time to starting free oral fluids and light diet, length of stay and survival.
There were no significant differences in age, sex, ASA grade and level of obstruction between the matched OGJ (n=16), LGJ (n=14) and ES (n=16) groups. There was a significant reduction in time to starting free oral fluids and light diet, and length of stay after the procedure, in the ES group. Patients who underwent surgical palliation of the obstruction had significantly more complications than those who underwent stenting (P=0.016). There were no significant differences in requirement for biliary drainage either before or after the procedure between the three groups. Survival was shortest in the ES group.
This matched study showed significant advantages for ES compared with OGJ and LGJ in the palliation of malignant pyloroduodenal obstruction.
幽门十二指肠梗阻的传统治疗方法是开放式胃空肠吻合术（OGJ）。最近，腹腔镜胃空肠吻合术（LGJ）和内镜支架置入术（ES）也已应用。本研究的目的是评估缓解恶性幽门十二指肠梗阻的三种方法。
从国际疾病分类（ICD）10编码和奥塔哥外科审计数据库中识别出1989年至2002年（含）期间在奥克兰市医院因恶性幽门十二指肠梗阻接受手术（开放手术和腹腔镜手术）的所有患者。从Endoscribe数据库中识别出接受内镜支架置入术的患者。对病历进行回顾，并将数据记录在结构化表格中。共有181例恶性幽门十二指肠梗阻患者，其中56例行OGJ，14例行LGJ，16例行ES。LGJ组和ES组的患者在麻醉医师协会（ASA）分级（I-V）、年龄（10岁以内）和梗阻部位（幽门、十二指肠第一部D1、D2、D3和D4）方面与接受OGJ的患者进行匹配。比较各组之间的主要结局指标为开始自由口服液体和清淡饮食的时间、住院时间和生存率。
匹配的OGJ组（n = 16）、LGJ组（n = 14）和ES组（n = 16）在年龄、性别、ASA分级和梗阻部位方面无显著差异。ES组术后开始自由口服液体和清淡饮食的时间以及住院时间显著缩短。接受梗阻手术姑息治疗的患者比接受支架置入术的患者并发症明显更多（P = 0.016）。三组患者术前或术后胆汁引流的需求无显著差异。ES组的生存率最短。
这项匹配研究表明，在缓解恶性幽门十二指肠梗阻方面，ES与OGJ和LGJ相比具有显著优势。
