Takeno Atsushi, Tamura Shigeyuki, Miki Hirofumi, Kawashima Hiroshi, Mukai Yosuke, Hamanaka Michiko, Ono Hisako, Uchiyama Chieko, Kanemura Takeshi, Suzuki Rei, Nakahira Shin, Nakata Ken, Okamura Shu, Takeda Yutaka, Kato Takeshi
Dept. of Gastroenterological Surgery, Kansai Rosai Hospital.
Gan To Kagaku Ryoho. 2011 Nov;38(12):2134-6.
Wallflex duodenal stent (WDS) placement for gastric outlet obstruction caused by malignant disease has been covered by health insurance in Japan since April 2010. We have placed five-WDS for three gastric outlet obstructions caused by inoperable advanced gastric cancer. CASE 1: A 67-year-old male diagnosed as having Stage IV gastric cancer with liver, lung, and lymph node metastases underwent a WDS placement during first-line chemotherapy. He was able to consume a soft diet orally for about five months thereafter. He underwent a WDS replacement for stent obstruction by tumor ingrowth and finally died due to the primary tumor 11 months after the first visit. CASE 2: A 63-year-old male diagnosed as having Stage IV gastric cancer with liver and lymph node metastases underwent a WDS placement during the first-line chemotherapy. He was able to consume a soft diet orally for about three months thereafter. He died due to the primary tumor six months after the first visit. CASE 3: A 72-year-old male diagnosed as having Stage IV gastric cancer with liver and lymph node metastases underwent a WDS placement during the first-line chemotherapy. He was able to consume a soft diet orally for about four months and subsequently received the fourth-line chemotherapy. He underwent a WDS replacement for stent obstruction by tumor ingrowth and finally died due to the primary tumor nine months after the first visit.
WDS stent placements for gastric outlet obstruction caused by inoperable advanced gastric cancer were performed safely and enabled the consumption of a soft diet orally for at least three months. This approach is expected to be a safe and effective treatment option.
自2010年4月起，日本医疗保险已涵盖用于治疗恶性疾病所致胃出口梗阻的Wallflex十二指肠支架（WDS）置入术。我们已为3例因无法手术的晚期胃癌导致的胃出口梗阻置入了5枚WDS。病例1：一名67岁男性被诊断为IV期胃癌，伴有肝、肺和淋巴结转移，在一线化疗期间接受了WDS置入术。此后他能够口服软食约5个月。他因肿瘤向内生长导致支架阻塞而接受了WDS置换，最终在首次就诊后11个月因原发性肿瘤死亡。病例2：一名63岁男性被诊断为IV期胃癌，伴有肝和淋巴结转移，在一线化疗期间接受了WDS置入术。此后他能够口服软食约3个月。他在首次就诊后6个月因原发性肿瘤死亡。病例3：一名72岁男性被诊断为IV期胃癌，伴有肝和淋巴结转移，在一线化疗期间接受了WDS置入术。他能够口服软食约4个月，随后接受了四线化疗。他因肿瘤向内生长导致支架阻塞而接受了WDS置换，最终在首次就诊后9个月因原发性肿瘤死亡。
对于因无法手术的晚期胃癌导致的胃出口梗阻，WDS支架置入术操作安全，能使患者口服软食至少3个月。这种方法有望成为一种安全有效的治疗选择。
