Miyamae Mahito, Komatsu Shuhei, Ichikawa Daisuke, Okamoto Kazuma, Kosuga Toshiyuki, Kubota Takeshi, Konishi Hirotaka, Morimura Ryo, Murayama Yasutoshi, Shiozaki Atsushi, Kuriu Yoshiaki, Ikoma Hisashi, Nakanishi Masayoshi, Fujiwara Hitoshi, Sakakura Chouhei, Otsuji Eigo
Dept. of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine.
Gan To Kagaku Ryoho. 2014 Nov;41(12):2331-3.
Prospective randomized controlled studies have indicated that endoscopic placement of self-expandable metal stents (SEMSs)is an effective treatment option for patients with malignant gastric outlet obstruction (GOO). We report a case of effective palliation of gastric cancer-related jejunum stricture with a SEMS. A7 7-year-old woman, who had previously undergone partial remnant gastrectomy and Roux-en-Y reconstruction, was diagnosed with abdominal recurrence of gastric cancer. After a 4 month observation period, which the patient opted for with informed consent, recurrent vomiting and loss of appetite ensued. Computed tomography (CT) and upper gastrointestinal series (UGI) examinations revealed a single intestinal stenosis caused by a recurrent tumor. Endoscopic placement of a SEMS palliated this intestinal obstruction, and her oral intake improved (GOOSS score improved from 0 to 3). Upper gastrointestinal series verified that the SEMS maintained its lumen 3 months after the procedure. Endoscopic treatment with a SEMS can be more effective for malignant intestinal stenosis caused by abdominal recurrence of gastric cancer, especially when it is difficult to laparotomy adhesion derived previous operation or peritonitis carcinomatosa. Further studies may be needed to clarify the clinical benefits of stent placement for patients with abdominal recurrence of gastric cancer.
前瞻性随机对照研究表明，内镜下放置自膨式金属支架（SEMSs）是治疗恶性胃出口梗阻（GOO）患者的一种有效选择。我们报告了1例应用SEMS有效缓解胃癌相关空肠狭窄的病例。一名77岁女性，既往接受过残胃部分切除术及Roux-en-Y重建术，被诊断为胃癌腹部复发。在患者知情同意后选择的4个月观察期后，出现反复呕吐和食欲减退。计算机断层扫描（CT）和上消化道造影（UGI）检查显示，复发肿瘤导致单一肠管狭窄。内镜下放置SEMS缓解了该肠梗阻，患者经口摄入量增加（GOOSS评分从0提高到3）。上消化道造影证实，术后3个月SEMS保持通畅。对于胃癌腹部复发导致的恶性肠狭窄，尤其是既往手术导致腹腔粘连或癌性腹膜炎难以行剖腹手术时，内镜下应用SEMS治疗可能更有效。可能需要进一步研究以阐明支架置入对胃癌腹部复发患者的临床益处。
