CAJ | 학술논문

目的：评价Y型自膨式全覆膜金属支架治疗毕Ⅱ式术后胃空肠吻合口良性狭窄的安全性和疗效。方法回顾分析郑州大学第一附属医院2008年1月至2014年6月收治的8例（胃癌2例，胃十二指肠溃疡6例）毕Ⅱ术式后出现并证实为胃空肠吻合口良性狭窄患者临床及影像学资料。根据残胃-空肠吻合口狭窄的特殊解剖结构病变特点，自行设计Y型一体化自膨式全覆膜金属支架。X线监视下对8例毕Ⅱ术式后胃肠吻合口良性狭窄患者置入8枚Y型一体化自膨式全覆膜金属支架。并于支架置入后1个月、3个月行上消化道造影检查，观察支架通。情况。3个月后X线监视下成功取出上述支架并随访4～18个月，观察患者进食通。情况，于4～6个月时行上消化道造影，了解胃肠吻合口通。情况。结果8例患者支架均一次性成功置入，置入后患者腹胀、恶心、呕吐症状消失；术后3个月所有患者支架均成功取出，无出血、吻合口瘘等并发症发生。术后所有患者均获得完整随访，其中1例胃十二指肠溃疡患者于支架置入术后5个月死于蛛网膜下腔出血；余7例患者4～6个月复查上消化道造影均未见吻合口再次狭窄，患者生活质量明显提高。结论 Y型自膨式全覆膜金属支架治疗毕Ⅱ式术后胃肠吻合口狭窄是安全和可行的，初步疗效令人满意，但尚需大量样本随机对照研究进一步验证。
목적：평개Y형자팽식전복막금속지가치료필Ⅱ식술후위공장문합구량성협착적안전성화료효。방법회고분석정주대학제일부속의원2008년1월지2014년6월수치적8례（위암2례，위십이지장궤양6례）필Ⅱ술식후출현병증실위위공장문합구량성협착환자림상급영상학자료。근거잔위-공장문합구협착적특수해부결구병변특점，자행설계Y형일체화자팽식전복막금속지가。X선감시하대8례필Ⅱ술식후위장문합구량성협착환자치입8매Y형일체화자팽식전복막금속지가。병우지가치입후1개월、3개월행상소화도조영검사，관찰지가통。정황。3개월후X선감시하성공취출상술지가병수방4～18개월，관찰환자진식통。정황，우4～6개월시행상소화도조영，료해위장문합구통。정황。결과8례환자지가균일차성성공치입，치입후환자복창、악심、구토증상소실；술후3개월소유환자지가균성공취출，무출혈、문합구루등병발증발생。술후소유환자균획득완정수방，기중1례위십이지장궤양환자우지가치입술후5개월사우주망막하강출혈；여7례환자4～6개월복사상소화도조영균미견문합구재차협착，환자생활질량명현제고。결론 Y형자팽식전복막금속지가치료필Ⅱ식술후위장문합구협착시안전화가행적，초보료효령인만의，단상수대량양본수궤대조연구진일보험증。
Objective To evaluate the feasibility and efficacy of a novel covered Y-shape expandable metal stent in managing benign anastomotic stenosis of billrothⅡoperation.Methods The clinical data and images of 8 patients(gastric cancer in 2 and gastroduodenal ulcer in 6)diagnosed as benign anastomotic stricture after billrothⅡoperation from January 2008 to June 2014 were retrospectively analyzed. According to the anatomic features of anastomosis of gastric remnant and jejunum,a kind of novel coated Y-shape self-expand metal stents was customized and then deployed in 8 cases under fluoroscopy.All patients underwent upper gastroenterography at post-procedural 1 month and 3 months to investigate the patency of stent.All stents got removed at 3 months after implantation if possible.The intakes of patients after stent being removed were evaluated and all patients were followed up for 4 to 18 months.Eight cases underwent upper gastroenterography at the follow-up of 4 to 6 months to investigate the anastomotic patency.Results All stents were successfully performed one-step and palliated abdominal distention, nausea and vomit of all patients.All stents were retrieved at post-procedural 3 months successfully and no complications such as bleeding,anastomotic leakage and so forth occurred.All patients were followed up for 4 to 18 months by upper gastroenterography.Only 1 patient with digestive tract ulcer died of subarachnoid hemorrhage 5 months after stent implantation.The upper gastroenterography of the other 7 cases,which achieved higher quality of life, indicated anastomotic patency.Conclusions The novel covered Y-shape expandable metal stent is a feasible and safe method of good short-term efficacy to manage the benign anastomotic stenosis of billrothⅡoperation. Additional randomized controlled studies of large sample are needed to verify the effectiveness of the stent.