Department of Internal Medicine, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama-City, Toyama, 930-8550, Japan.
Surg Endosc. 2020 May;34(5):2103-2112. doi: 10.1007/s00464-019-06991-9. Epub 2019 Jul 23.
Malignant afferent loop obstruction (mALO) can cause cholangitis, pancreatitis, and perforation due to blind loop dilatation. However, peritoneal dissemination, lymph node metastasis, and recurrence of the tumor are the main causes of mALO, and most cases are in the advanced stage with thoracicoabdominal fluid retention, for which surgery and percutaneous transhepatic treatment are challenging. At our hospital, endoscopic metal stent placement (EMSP) has been applied for such mALO. We retrospectively investigated the usefulness of EMSP for mALO.
We conducted a retrospective analysis of 11 mALO patients with EMSP between January 2008 and December 2018. The following items were evaluated: the characteristics of patients, technical success and adverse events of EMSP, clinical efficacy, and outcome after EMSP.
The surgical procedures and reconstruction methods were distal gastrectomy with Billroth II reconstruction for 3 patients, pancreaticoduodenectomy with modified-Child reconstruction for 7, choledochojejunostomy with Roux-en-Y reconstruction for 1. The cause of mALO was peritoneal dissemination for 6 patients, local recurrence for 3, lymph node metastasis for 1, and afferent loop invasion for 1. EMSP was attempted in 13 sessions for 11 patients, and successful in 12 of 13 sessions. There were no adverse events. The clinical efficacy was high in successful EMSP. The median survival time after EMSP was 118 days. Ten patients died of primary disease and one patient died of uncontrollable cholangitis after the failure of EMSP. mALO recurred and EMSP was repeated for 2 of 10 patients who died of primary disease.
The success rate of EMSP for mALO was high in patients with poor general conditions due to advanced-stage malignant tumors and it was able to be safely performed, suggesting its high clinical efficacy. The incidence of mALO recurrence after EMSP was low.
恶性输入襻梗阻（mALO）可因盲襻扩张而导致胆管炎、胰腺炎和穿孔。然而，腹膜扩散、淋巴结转移和肿瘤复发是 mALO 的主要原因，且大多数病例处于晚期，伴有胸腹积液，因此手术和经皮肝穿刺治疗具有挑战性。在我院，已应用内镜下金属支架置入术（EMSP）治疗此类 mALO。我们回顾性研究了 EMSP 治疗 mALO 的有效性。
我们对 2008 年 1 月至 2018 年 12 月期间 11 例接受 EMSP 的 mALO 患者进行了回顾性分析。评估内容包括：患者特征、EMSP 的技术成功率和不良事件、临床疗效以及 EMSP 后的结局。
手术方式和重建方法分别为：3 例患者行远端胃大部切除术+Billroth II 式吻合，7 例行胰十二指肠切除术+改良 Child 式吻合，1 例行胆肠吻合+Roux-en-Y 式吻合。mALO 的病因分别为：腹膜扩散 6 例、局部复发 3 例、淋巴结转移 1 例、输入襻侵犯 1 例。11 例患者共尝试 13 次 EMSP，12 次成功。无不良事件发生。EMSP 成功患者的临床疗效较高。EMSP 后中位生存时间为 118 天。10 例患者死于原发疾病，1 例患者因 EMSP 失败并发不可控性胆管炎而死亡。10 例死于原发疾病的患者中有 2 例 mALO 复发并再次接受 EMSP。
对于因晚期恶性肿瘤而一般状况较差的 mALO 患者，EMSP 的成功率较高，且能够安全进行，提示其具有较高的临床疗效。EMSP 后 mALO 复发的发生率较低。
