老年胃十二指肠恶性狭窄支架并动脉灌注治疗

摘要

目的 探讨老年胃十二指肠恶性狭窄患者的支架置入方法,评价支架置入后序贯行动脉灌注化疗的作用.方法 75岁以上高龄老年胃十二指肠恶性狭窄患者32例.在X线监视下经口行超滑导丝导管并使之过胃十二指肠狭窄或阻塞段;经交换导管替换软头特硬导丝后引人镍钛合金支架及套管式推送器将支架送入狭窄段,置入金属支架.其中15例患者给予1 ～ 3次经动脉药物灌注和栓塞治疗.结果 32例成功地放置了35枚胃十二指肠支架.术中患者生命体征平稳,未出现缺氧、呛咳、误吸等不良情况.支架置人后患者临床症状完全缓解30例,部分缓解2例.术后1个月复查支架通畅率93.6%,中位生存期为6.3个月.结论 高龄老年恶性病患者能安全接受经口十二指肠支架置入术.%Objective To discuss the technical points of stent implantation for malignantgastroduodenal stenosis in elderly patients , and to evaluate the clinical efficacy of metal stenting combined with arterial infusion. Methods A total of 32 patients of malignant gastroduodenal stenosis with ages over 75 years were enrolled in this study. Proper nursing care and medication were carried out during the perioperative period. Under fluoroscopic guidance , the catheter was orally inserted along a guidewire into the stomach and was pushed forward until the catheter tip passed through the gastroduodenal stricture or the obstructed segment. By using catheter exchange technique, the special super-hard guidewire with soft head was replaced by a delivery catheter system , through which the nickel-titanium alloy stent was placed in the narrowed segment. One to three times of arterial infusion and embolization were given to 15 patients. After the procedure, all the patients were kept under careful observation. Results A total of 35 gastroduodenal stents were successfully placed in 32 patients. During the procedure , the vital signs were stable in all patients and no hypoxia, coughing, aspiration or other adverse effects occurred. After stent implantation , the clinical symptoms were completely relieved in 30 cases , partially relieved in 2 cases. One month after the treatment, the stent patency rate was 93.6%. The median survival rate was 6.3 months. Conclusion Peroral duodenal stent implantation can be safely performed in elderly patients with malignant gastroduodenal stenosis. When combined with intra-arterial chemotherapy , the patient' s living quality can be effectively improved and the survival time can be elongated. (J Intervent Radiol, 2012, 21: 418-421)