CAJ | 학술논문

目的比较内镜下支架置入术和外科手术治疗恶性幽门梗阻的患者的优缺点.方法回顾性分析2007年至2014年因恶性幽门梗阻接受支架治疗的29例患者和外科手术治疗的42例患者资料,比较支架及外科手术的成功率,以及2组患者术后进食、并发症、住院时间和费用等情况.结果幽门支架与外科手术均能有效恢复患者进食,治疗前后的GOOSS评分相比差异均有统计学意义(P＜0.05),但支架组评分提高速度快于手术组.支架组与手术组的技术成功率均为100％,临床成功率分别为96.6％和92.9％,2组成功率差异无统计学意义(P值均≥0.05).支架组早期并发症发生率低于手术组(3.4％比23.8％,P＜0.05),晚期并发症高于手术组(24.1％比6.9％,P＜0.05);支架组主要并发症多为再梗阻,手术组则是感染、吻合口瘘;主要并发症的发生率2组无明显差异(27.6％比11.9％,P＞0.05).支架与手术相比术后开始进食时间、住院时间和费用均有明显降低(P值均＜0.05).结论内镜下支架置入术和外科手术均能有效缓解恶性幽门梗阻患者的症状,但支架治疗恢复进食快,住院时间短费用低,早期并发症少且晚期并发症大多可内镜下治疗,对预期生存期较短的患者来说是更好的选择.
목적 비교내경하지가치입술화외과수술치료악성유문경조적환자적우결점.방법 회고성분석2007년지2014년인악성유문경조접수지가치료적29례환자화외과수술치료적42례환자자료,비교지가급외과수술적성공솔,이급2조환자술후진식、병발증、주원시간화비용등정황.결과 유문지가여외과수술균능유효회복환자진식,치료전후적GOOSS평분상비차이균유통계학의의(P＜0.05),단지가조평분제고속도쾌우수술조.지가조여수술조적기술성공솔균위100％,림상성공솔분별위96.6％화92.9％,2조성공솔차이무통계학의의(P치균≥0.05).지가조조기병발증발생솔저우수술조(3.4％비23.8％,P＜0.05),만기병발증고우수술조(24.1％비6.9％,P＜0.05);지가조주요병발증다위재경조,수술조칙시감염、문합구루;주요병발증적발생솔2조무명현차이(27.6％비11.9％,P＞0.05).지가여수술상비술후개시진식시간、주원시간화비용균유명현강저(P치균＜0.05).결론 내경하지가치입술화외과수술균능유효완해악성유문경조환자적증상,단지가치료회복진식쾌,주원시간단비용저,조기병발증소차만기병발증대다가내경하치료,대예기생존기교단적환자래설시경호적선택.
Objective To compare surgical gastrojejunostomy and endoscopic stenting in palliation of malignant gastric outlet obstruction.Methods This retrospective study investigated patients treated for malignant gastric outlet obstruction from January 2007 to January 2014 in the first affiliated hospital of Nanjing Medical University.Endoscopic stenting was placed in 29 patients and surgical gastrojejunostomy was performed in 42 patients.The outcomes assessed included diet scores,time to diet,length of hospital stay,treatments fees and complications.Results Both endoscopic stenting and surgical gastrojejunostomy can relieve patients' syndrome with significant higher GOOSS score compared with that before treatment (P ＜0.05),but score improves faster in stenting group.Clinical success for endoscopic stenting and surgical gastrojejunostomy was 96.6％ and 92.9％ respectively,and technical success was 100％ for both of them.Endoscopic stenting group was found to have lower early complication rate(3.4％ VS 23.8％,P ＜0.05),higher late complication rate(24.1％ VS 6.9％,P ＜0.05),less time to diet,hospital stay and treatment fees(all P value ＜ 0.05)than surgical gastrojejunostomy group.The major complication after endoscopic stenting is re-obstruction while it is infection and leak of anastomotic site for surgical group.There were no significant differences in complication between two groups (27.6％ VS 11.9％,P ＞ 0.05).Conclusion Both endoscopic stenting and surgical gastrojejunostomy can relieve patients' syndrome effectively and safely,but endoscopic stenting improves GOOSS scores more rapid with less time to diet,less early complication rate and easy-dealing late complications,also it needs less hospital stay and fees.It's a better choice for patients with less survival expectation.