Department of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32610, United States.
World J Gastroenterol. 2009 Sep 21;15(35):4365-71. doi: 10.3748/wjg.15.4365.
Malignant gastroduodenal obstruction can occur in up to 20% of patients with primary pancreatic, gastric or duodenal carcinomas. Presenting symptoms include nausea, vomiting, abdominal distention, pain and decreased oral intake which can lead to dehydration, malnutrition, and poor quality of life. Endoscopic stent placement has become the primary therapeutic modality because it is safe, minimally invasive, and a cost-effective option for palliation. Stents can be successfully deployed in the majority of patients. Stent placement appears to lead to a shorter time to symptomatic improvement, shorter time to resumption of an oral diet, and shorter hospital stays as compared with surgical options. Recurrence of the obstructive symptoms resulting from stent occlusion, due to tumor ingrowth or overgrowth, can be successfully treated with repeat endoscopic stent placement in the majority of the cases. Both endoscopic stenting and surgical bypass are considered palliative treatments and, to date, no improvement in survival with either modality has been demonstrated. A tailored therapeutic approach, taking into consideration patient preferences and involving a multidisciplinary team including the therapeutic endoscopist, surgeon, medical oncologist, radiation therapist, and interventional radiologist, should be considered in all cases.
恶性胃十二指肠梗阻可发生于多达 20%的原发性胰腺、胃或十二指肠癌患者中。其主要表现为恶心、呕吐、腹胀、腹痛和摄食量减少，这些症状可导致脱水、营养不良和生活质量下降。内镜下支架置入术已成为主要的治疗方法，因为它安全、微创，并且是一种具有成本效益的姑息治疗选择。支架在大多数患者中都能成功放置。与手术治疗相比，支架置入术可更快地缓解症状，更快地恢复口服饮食，住院时间更短。由于肿瘤向内生长或过度生长导致支架阻塞引起的梗阻症状复发，在大多数情况下可以通过再次内镜下支架置入术成功治疗。内镜下支架置入和手术旁路均被认为是姑息性治疗，迄今为止，这两种方法都没有显示出对生存时间的改善。在所有情况下，都应考虑采用个体化的治疗方法，考虑患者的偏好，并涉及包括治疗性内镜医生、外科医生、肿瘤内科医生、放射治疗师和介入放射科医生在内的多学科团队。
