Trotter J M, Balamurugan R, Dear K L, Naylor G M, Everitt N J, Ravi K
Department of General Surgery, Chesterfield Royal Hospital NHS Foundation Trust, Calow, Chesterfield, Derbyshire, S44 5BL, UK.
Ann R Coll Surg Engl. 2015 Jan;97(1):32-4. doi: 10.1308/003588414X14055925058995.
Malignant gastric outlet obstruction (GOO) is a common, debilitating and frequently pre-terminal symptom of intra-abdominal malignancies. Traditional 'gold standard' treatment has been palliative surgical gastro-enterostomy. Over the past two decades, use of self-expanding metallic stents (SEMSs) to relieve malignant GOO has become first-line treatment. We present the results from a single district general hospital in the UK in which malignant GOO was treated with SEMSs over a six-year period.
All patients who underwent palliative stenting for malignant gastro-duodenal tumours in our centre for six years up to January 2013 were assessed retrospectively. Outcomes were assessed with regard to: technical and clinical success; return to oral nutrition; prevalence of complications and re-intervention; and overall survival.
Thirty-two stents were implanted in 29 patients. Technical success was 100%. Clinical success and return to oral nutrition were both 91%. The prevalence of complications was 16%. The prevalence of re-intervention was 13%. Mean survival was 91 (range, 5-392) days. Median wait from decision to implant a stent to stent implantation was 1 (range, 0-14) day. Overall, 25 covered and nine uncovered stents were implanted.
Stent implantation for GOO in this patient group is an established and preferable alternative to surgical intervention. Much of the treatment for malignancies of the upper gastrointestinal tract has now been centralised. Our data showed comparable results with published data for these procedures, with a high prevalence of success and low prevalence of major complications. It is of considerable benefit to these patients not to have to travel to a regional centre for stent implantation.
恶性胃出口梗阻（GOO）是腹腔内恶性肿瘤常见、使人衰弱且常为终末期的症状。传统的“金标准”治疗方法是姑息性外科胃肠吻合术。在过去二十年中，使用自膨式金属支架（SEMS）缓解恶性GOO已成为一线治疗方法。我们展示了英国一家地区综合医院在六年内使用SEMS治疗恶性GOO的结果。
回顾性评估了截至2013年1月在我们中心接受姑息性支架置入治疗恶性胃十二指肠肿瘤的所有患者。评估结果包括：技术和临床成功率；恢复经口营养情况；并发症和再次干预的发生率；以及总生存期。
29例患者共植入32枚支架。技术成功率为100%。临床成功率和恢复经口营养率均为91%。并发症发生率为16%。再次干预发生率为13%。平均生存期为91天（范围5 - 392天）。从决定植入支架到支架植入的中位等待时间为1天（范围0 - 14天）。总体而言，共植入25枚覆膜支架和9枚非覆膜支架。
对于该患者群体，植入支架治疗GOO是一种既定且优于手术干预的选择。现在，大部分上消化道恶性肿瘤的治疗已集中进行。我们的数据显示这些手术的结果与已发表的数据相当，成功率高且主要并发症发生率低。对于这些患者来说，无需前往区域中心进行支架植入有很大益处。
