Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK.
Department of Upper Gastrointestinal Surgery, The New Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2TH, UK.
Cardiovasc Intervent Radiol. 2013 Dec;36(6):1591-1601. doi: 10.1007/s00270-013-0584-4. Epub 2013 Mar 2.
Self-expanding metallic stents (SEMS) are used to palliate malignant gastric outlet obstruction (GOO) and are useful in patients with limited life expectancy or severe medical comorbidity, which would preclude surgery. Stenting can be performed transorally or by a percutaneous transgastric technique. Our goal was to review the outcome of patients who underwent radiological SEMS insertion performed by a single consultant interventional radiologist.
Patients were identified from a prospectively collected database held by one consultant radiologist. Data were retrieved from radiological reports, multidisciplinary team meetings, and the patients' case notes. Univariate survival analysis was performed.
Between December 2000 and January 2011, 100 patients (63 males, 37 females) had 110 gastroduodenal stenting procedures. Median age was 73 (range 39-89) years. SEMS were inserted transorally (n = 66) or transgastrically (n = 44). Site of obstruction was the stomach (n = 37), duodenum (n = 50), gastric pull-up (n = 10), or gastroenterostomy (n = 13). Seven patients required biliary stents. Technical success was 86.4 %: 83.3 % for transoral insertion, 90.9 % for transgastric insertion. Eleven patients developed complications. Median GOO severity score: 1 pre-stenting, 2 post-stenting (p = 0.0001). Median survival was 54 (range 1-624) days. Post-stenting GOO severity score was predictive of survival (p = 0.0001).
The technical success rate for insertion of palliative SEMS is high. Insertional technique can be tailored to the individual depending on the location of the tumor and whether it is possible to access the stomach percutaneously. Patients who have successful stenting and return to eating a soft/normal diet have a statistically significant increase in survival.
自膨式金属支架（SEMS）用于姑息性治疗恶性胃出口梗阻（GOO），对于预期寿命有限或存在严重合并症的患者非常有用，这些患者不能接受手术。支架置入可经口或经皮经胃途径进行。我们的目标是回顾单一介入放射学顾问进行放射学 SEMS 置入的患者的结果。
通过一名顾问放射科医生的前瞻性收集数据库确定患者。从放射学报告、多学科团队会议和患者的病例记录中获取数据。进行单变量生存分析。
2000 年 12 月至 2011 年 1 月，100 名患者（63 名男性，37 名女性）接受了 110 例胃十二指肠支架置入术。中位年龄为 73 岁（范围 39-89 岁）。SEMS 通过经口（n = 66）或经胃（n = 44）途径置入。梗阻部位为胃（n = 37）、十二指肠（n = 50）、胃上提（n = 10）或胃肠吻合术（n = 13）。7 例患者需要胆道支架。技术成功率为 86.4%：经口插入成功率为 83.3%，经胃插入成功率为 90.9%。11 例患者发生并发症。中位 GOO 严重程度评分：支架置入前为 1，支架置入后为 2（p = 0.0001）。中位生存时间为 54 天（范围 1-624 天）。支架置入后 GOO 严重程度评分与生存相关（p = 0.0001）。
姑息性 SEMS 置入的技术成功率很高。根据肿瘤位置和是否能够经皮穿刺进入胃，可以为每位患者量身定制插入技术。支架置入成功并恢复软/正常饮食的患者，其生存时间有显著统计学意义的增加。
