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年轻女性十二指肠颈转移致恶性胃出口梗阻:会师技术。

Malignant Gastric Outlet Obstruction Caused by Duodenal Cervix Metastasis in a Young Woman: Rendezvous Technique.

机构信息

Department of Surgery, University of Naples Federico II, 80138 Naples, Italy.

Department of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy.

出版信息

Medicina (Kaunas). 2021 Jul 28;57(8):765. doi: 10.3390/medicina57080765.

Abstract

: Malignant gastric outlet obstruction (MGOD) is an extremely rare expression of advanced extra-gastrointestinal cancer, such as squamous cell carcinoma (SCC) of the cervix, and only sixcases are described in the literature.Because of the short life expectancyand the high surgical risk involving these patients, less invasive approaches have been developed over time, such asthe use of an enteral stent or less invasive surgical techniques (i.e., laparoscopic gastrojejunostomy). However, MGOD could make it difficult to perform an endoscopic retrograde cholangio-pancreatography (ERCP) for standard endoscopic drainage, so in this case a combined endoscopic-percutaneous technique may be performed. This article, therefore, aims to highlight the presence in the doctor's armamentarium of the "rendezvous technique", few case reports of whichare described in the literature, and, moreover, this article aims to underline the technique'sfeasibility. Case Presentation: The case is that of a 38-year-old woman who presented with MGOD three years after the diagnosis of SCC of the cervix, who successfully underwent the rendezvous technique with the resolution of duodenal obstruction. Endoscopic enteral stenting treatment with the placement of a metal stent (SEMSs) represents the mainstay of MGOD treatment compared withsurgery due to its lower morbidity, mortality, shorter hospitalization and earlier symptom relief. However, in patients with both duodenal and biliary obstruction, a combined endoscopic-percutaneous approach may be necessary because of the difficulty in passing the duodenal stricture or in accessing the papilla through the mesh of the duodenal SEMS. : The rendezvous procedure is a technicallyfeasible and minimally invasive approach to the double stenting of biliary and duodenal strictures. It achieves the desired therapeutic result while avoiding the need to perform more invasive procedures that could have a negative impact on the patient'sprognosis.

摘要

胃出口恶性梗阻(MGOD)是一种极为罕见的晚期胃肠外癌症表现,如宫颈癌的鳞状细胞癌(SCC),文献中仅描述了 6 例。由于这些患者的预期寿命短且手术风险高,因此随着时间的推移,已经开发出了一些侵入性较小的方法,例如使用肠内支架或侵入性较小的手术技术(即腹腔镜胃空肠吻合术)。然而,MGOD 可能会使标准内镜引流难以进行内镜逆行胰胆管造影(ERCP),因此在这种情况下,可以进行联合内镜经皮技术。因此,本文旨在强调医生的“会师技术”的存在,文献中很少有病例报告描述了这种技术,而且,本文旨在强调该技术的可行性。病例介绍:该病例是一名 38 岁女性,在诊断为宫颈癌 SCC 后 3 年出现 MGOD,成功通过会师技术解决了十二指肠梗阻。与手术相比,内镜肠内支架置入术(SEMSs)治疗 MGOD 具有较低的发病率、死亡率、较短的住院时间和更早的症状缓解,是其主要治疗方法。然而,对于同时存在十二指肠和胆道梗阻的患者,由于难以通过十二指肠狭窄或通过十二指肠 SEMS 的网孔进入乳头,可能需要联合内镜经皮方法。结论:会师手术是一种技术上可行且微创的方法,可对胆道和十二指肠狭窄进行双重支架置入。它在避免进行可能对患者预后产生负面影响的更具侵入性的程序的同时,达到了预期的治疗效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/da7c/8401765/ca6b9994dce1/medicina-57-00765-g001.jpg

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