内镜下十二指肠支架置入术有效，但在胃出口梗阻的姑息治疗中，与胃空肠吻合术相比，再手术率更高。
Endoscopic duodenal stenting is efficient, but has higher rate of reoperations than gastrojejunostomy in palliative treatment for gastric outlet obstruction.
机构信息
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Kuntokatu 2, 33520, ElämänaukioTampere, Finland.
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
出版信息
Langenbecks Arch Surg. 2022 Sep;407(6):2509-2515. doi: 10.1007/s00423-022-02565-x. Epub 2022 Jun 1.
BACKGROUND
Surgical gastrojejunostomy has traditionally been the palliative treatment of choice for patients with advanced malignancies and gastric outlet obstruction syndrome. Recently, palliative endoscopic duodenal stenting has increased in popularity. We report outcomes after gastrojejunostomy and duodenal stenting when used for palliative indications.
METHODS
Consecutive patients undergoing palliative gastrojejunostomy or palliative endoscopic duodenal stenting in a Finnish tertiary referral center between January 2015 and December 2020 were included. The postoperative outcomes of these two palliative interventions were compared. The main outcome measures were mortality and morbidity, rate of reoperations, postoperative oral intake ability, and length of hospital stay.
RESULTS
A total of 88 patients, 46 (52%) patients underwent palliative gastrojejunostomy and 42 (48%) duodenal stenting. All patients had malignant disease, most typically hepatopancreatic cancer. Nineteen (44%) patients in duodenal stenting group and 4 (8.7%) patients in gastrojejunostomy group required subsequent interventions due to persisting or progressing symptoms (p < 0.001). Median delay until first oral intake was 2 days (1-24) after gastrojejunostomy and 0 days (0-3) after stenting (p < 0.001). Postoperative morbidity was 30% after gastrojejunostomy and 45% after stenting (p < 0.001). Median length of hospital stay was 7 days (1-27) after surgery and 5 days (0-20) after endoscopy (p < 0.001).
CONCLUSIONS
Patients undergoing endoscopic duodenal stenting are more able to initiate rapid oral intake and have shorter hospital stay. On the other hand, there are significantly more reoperations in stenting group. If the patient's life expectancy is short, we recommend stenting, but for patients whose life expectancy is longer, gastrojejunostomy could be a better procedure, for the reasons mentioned above.
背景
手术胃空肠吻合术一直是晚期恶性肿瘤和胃出口梗阻综合征患者的姑息性治疗选择。最近，姑息性内镜十二指肠支架置入术的应用日益普及。我们报告了用于姑息性适应证时胃空肠吻合术和十二指肠支架置入术的结果。
方法
纳入 2015 年 1 月至 2020 年 12 月期间在芬兰三级转诊中心接受姑息性胃空肠吻合术或姑息性内镜十二指肠支架置入术的连续患者。比较这两种姑息性干预的术后结果。主要观察指标为死亡率和发病率、再手术率、术后口服摄入能力和住院时间。
结果
共纳入 88 例患者，其中 46 例（52%）接受姑息性胃空肠吻合术，42 例（48%）接受十二指肠支架置入术。所有患者均患有恶性疾病，最常见的是肝胰癌症。支架置入组中有 19 例（44%）患者和胃空肠吻合组中有 4 例（8.7%）患者因持续或进展的症状需要进一步干预（p<0.001）。胃空肠吻合术后首次口服摄入的中位延迟时间为 2 天（1-24 天），而支架置入术后为 0 天（0-3 天）（p<0.001）。胃空肠吻合术后的术后发病率为 30%，支架置入术后为 45%（p<0.001）。手术和内镜后的中位住院时间分别为 7 天（1-27 天）和 5 天（0-20 天）（p<0.001）。
结论
接受内镜十二指肠支架置入术的患者能够更快地开始口服摄入，住院时间更短。另一方面，支架置入组的再手术率明显更高。如果患者的预期寿命较短，我们建议进行支架置入，但对于预期寿命较长的患者，胃空肠吻合术可能是更好的选择，原因如前所述。
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